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Sajobi TT, Arimoro OI, Ademola A, Singh N, Bala F, Almekhlafi MA, Deschaintre Y, Coutts SB, Thirunavukkarasu S, Khosravani H, Appireddy R, Moreau F, Gubitz GJ, Tkach A, Catanese L, Dowlatshahi D, Medvedev G, Mandzia J, Pikula A, Shankar JS, Williams H, Field TS, Manosalva A, Siddiqui M, Zafar A, Imoukhuede O, Hunter G, Demchuk AM, Mishra SM, Gioia LC, Jalini S, Cayer C, Phillips SJ, Elamin E, Shoamanesh A, Subramaniam S, Kate MP, Jacquin G, Camden MC, Benali F, Alhabli I, Horn M, Stotts G, Hill MD, Gladstone DJ, Poppe AY, Sehgal A, Zhang Q, Lethebe B, Doram C, Shamy M, Kenney C, Buck BH, Swartz RH, Menon BK. Quality of Life After Intravenous Thrombolysis for Acute Ischemic Stroke: Results From the AcT Randomized Controlled Trial. Stroke 2024; 55:524-531. [PMID: 38275116 DOI: 10.1161/strokeaha.123.044690] [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: 05/09/2023] [Accepted: 11/30/2023] [Indexed: 01/27/2024]
Abstract
BACKGROUND Recent evidence from thrombolysis trials indicates the noninferiority of intravenous tenecteplase to intravenous alteplase with respect to good functional outcomes in patients with acute stroke. We examined whether the health-related quality of life (HRQOL) of patients with acute stroke differs by the type of thrombolysis treatment received. In addition, we examined the association between the modified Rankin Scale score 0 to 1 and HRQOL and patient-reported return to prebaseline stroke functioning at 90 days. METHODS Data were from all patients included in the AcT trial (Alteplase Compared to Tenecteplase), a pragmatic, registry-linked randomized trial comparing tenecteplase with alteplase. HRQOL at 90-day post-randomization was assessed using the 5-item EuroQOL questionnaire (EQ5D), which consists of 5 items and a visual analog scale (VAS). EQ5D index values were estimated from the EQ5D items using the time tradeoff approach based on Canadian norms. Tobit regression and quantile regression models were used to evaluate the adjusted effect of tenecteplase versus alteplase treatment on the EQ5D index values and VAS score, respectively. The association between return to prebaseline stroke functioning and the modified Rankin Scale score 0 to 1 and HRQOL was quantified using correlation coefficient (r) with 95% CI. RESULTS Of 1577 included in the intention-to-treat analysis patients, 1503 (95.3%) had complete data on the EQ5D. Of this, 769 (51.2%) were administered tenecteplase and 717 (47.7%) were female. The mean EQ5D VAS score and EQ5D index values were not significantly higher for those who received intravenous tenecteplase compared with those who received intravenous alteplase (P=0.10). Older age (P<0.01), more severe stroke assessed using the National Institutes of Health Stroke Scale (P<0.01), and longer stroke onset-to-needle time (P=0.004) were associated with lower EQ5D index and VAS scores. There was a strong association (r, 0.85 [95% CI, 0.81-0.89]) between patient-reported return to prebaseline functioning and modified Rankin Scale score 0 to 1 Similarly, there was a moderate association between return to prebaseline functioning and EQ5D index (r, 0.45 [95% CI, 0.40-0.49]) and EQ5D VAS scores (r, 0.42 [95% CI, 0.37-0.46]). CONCLUSIONS Although there is no differential effect of thrombolysis type on patient-reported global HRQOL and EQ 5D-5L index values in patients with acute stroke, sex- and age-related differences in HRQOL were noted in this study. REGISTRATION URL: https://www.clinicaltrials.gov; Unique identifier: NCT03889249.
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Affiliation(s)
- Tolulope T Sajobi
- Department of Community Health Sciences, University of Calgary, AB, Canada (T.T.S., O.I.A., A.A., M.A.A., S.B.C., A.M.D., M.D.H., B.L., B.K.M.)
- Department of Clinical Neurosciences (T.T.S., A.A., M.A.A., S.B.C., A.M.D., S.S., F. Benali, I.A., M.H., M.D.H., A. Sehgal, Q.Z., C.D., C.K., B.K.M.), Cumming School of Medicine, University of Calgary, AB, Canada
| | - Olayinka I Arimoro
- Department of Community Health Sciences, University of Calgary, AB, Canada (T.T.S., O.I.A., A.A., M.A.A., S.B.C., A.M.D., M.D.H., B.L., B.K.M.)
| | - Ayoola Ademola
- Department of Community Health Sciences, University of Calgary, AB, Canada (T.T.S., O.I.A., A.A., M.A.A., S.B.C., A.M.D., M.D.H., B.L., B.K.M.)
- Department of Clinical Neurosciences (T.T.S., A.A., M.A.A., S.B.C., A.M.D., S.S., F. Benali, I.A., M.H., M.D.H., A. Sehgal, Q.Z., C.D., C.K., B.K.M.), Cumming School of Medicine, University of Calgary, AB, Canada
| | - Nishita Singh
- Max Rady College of Medicine, University of Manitoba, Winnipeg, Canada (N.S., J.S.S.)
- University of Manitoba, Winnipeg, Canada (N.S., J.S.S.)
| | - Fouzi Bala
- Department of Diagnostic and Interventional Neuroradiology, Tours University Hospital, France (F. Bala)
| | - Mohammed A Almekhlafi
- Department of Community Health Sciences, University of Calgary, AB, Canada (T.T.S., O.I.A., A.A., M.A.A., S.B.C., A.M.D., M.D.H., B.L., B.K.M.)
- Department of Clinical Neurosciences (T.T.S., A.A., M.A.A., S.B.C., A.M.D., S.S., F. Benali, I.A., M.H., M.D.H., A. Sehgal, Q.Z., C.D., C.K., B.K.M.), Cumming School of Medicine, University of Calgary, AB, Canada
- Department of Radiology (M.A.A., S.B.C., A.M.D., M.D.H., B.K.M.), Cumming School of Medicine, University of Calgary, AB, Canada
- Hotchkiss Brain Institute, Calgary, AB, Canada (M.A.A., S.B.C., A.M.D., M.D.H., B.K.M.)
| | - Yan Deschaintre
- Département of Neurosciences, Université de Montréal, QC, Canada (Y.D., L.C.G., G.J., A.Y.P.)
- Centre Hospitalier de l'Université de Montréal, QC, Canada (Y.D., L.C.G., G.J., A.Y.P.)
| | - Shelagh B Coutts
- Department of Community Health Sciences, University of Calgary, AB, Canada (T.T.S., O.I.A., A.A., M.A.A., S.B.C., A.M.D., M.D.H., B.L., B.K.M.)
- Department of Clinical Neurosciences (T.T.S., A.A., M.A.A., S.B.C., A.M.D., S.S., F. Benali, I.A., M.H., M.D.H., A. Sehgal, Q.Z., C.D., C.K., B.K.M.), Cumming School of Medicine, University of Calgary, AB, Canada
- Department of Radiology (M.A.A., S.B.C., A.M.D., M.D.H., B.K.M.), Cumming School of Medicine, University of Calgary, AB, Canada
- Hotchkiss Brain Institute, Calgary, AB, Canada (M.A.A., S.B.C., A.M.D., M.D.H., B.K.M.)
| | - Sibi Thirunavukkarasu
- Division of Neurology, Department of Medicine, University of Alberta, Edmonton, Canada (S.T., S.M.M., M.P.K., B.H.B.)
| | - Houman Khosravani
- Division of Neurology, Department of Medicine, Hurvitz Brain Sciences Program, Sunnybrook Health Sciences Centre, University of Toronto, ON, Canada (H.K., D.J.G., R.H.S.)
| | - Ramana Appireddy
- Division of Neurology, Department of Medicine, Queen's University, Kingston, ON, Canada (R.A., S.J.)
| | | | - Gordon J Gubitz
- Queen Elizabeth Health Sciences Centre, Halifax, NS, Canada (G.J.G., S.J.P., A. Shoamanesh)
| | | | - Luciana Catanese
- Hamilton Health Sciences Centre, McMaster University, Hamilton, ON, Canada (L.C.)
| | - Dar Dowlatshahi
- Department of Medicine, Ottawa Heart Research Institute, University of Ottawa, ON, Canada (D.D., M. Shamy)
| | - George Medvedev
- Department of Medicine, University of British Columbia & Fraser Health Authority, New Westminster, BC, Canada (G.M., G.S.)
- University of British Columbia, Fraser Health Authority, New Westminster, BC, Canada (G.M., G.S.)
| | - Jennifer Mandzia
- London Health Sciences Centre and Western University, ON, Canada (J.M.)
| | | | - Jai Shiva Shankar
- Max Rady College of Medicine, University of Manitoba, Winnipeg, Canada (N.S., J.S.S.)
- University of Manitoba, Winnipeg, Canada (N.S., J.S.S.)
| | | | - Thalia S Field
- Vancouver Stroke Program, Division of Neurology, The University of British Columbia, Vancouver, Canada (T.S.F.)
| | | | | | - Atif Zafar
- St. Michael's Hospital, Toronto, ON, Canada (A.Z.)
| | | | - Gary Hunter
- University of Saskatchewan, Saskatoon, Canada (G.H.)
| | - Andrew M Demchuk
- Department of Community Health Sciences, University of Calgary, AB, Canada (T.T.S., O.I.A., A.A., M.A.A., S.B.C., A.M.D., M.D.H., B.L., B.K.M.)
- Department of Clinical Neurosciences (T.T.S., A.A., M.A.A., S.B.C., A.M.D., S.S., F. Benali, I.A., M.H., M.D.H., A. Sehgal, Q.Z., C.D., C.K., B.K.M.), Cumming School of Medicine, University of Calgary, AB, Canada
- Department of Radiology (M.A.A., S.B.C., A.M.D., M.D.H., B.K.M.), Cumming School of Medicine, University of Calgary, AB, Canada
| | - Sachin M Mishra
- Hotchkiss Brain Institute, Calgary, AB, Canada (M.A.A., S.B.C., A.M.D., M.D.H., B.K.M.)
- Division of Neurology, Department of Medicine, University of Alberta, Edmonton, Canada (S.T., S.M.M., M.P.K., B.H.B.)
| | - Laura C Gioia
- Département of Neurosciences, Université de Montréal, QC, Canada (Y.D., L.C.G., G.J., A.Y.P.)
- Centre Hospitalier de l'Université de Montréal, QC, Canada (Y.D., L.C.G., G.J., A.Y.P.)
| | - Shirin Jalini
- Division of Neurology, Department of Medicine, Queen's University, Kingston, ON, Canada (R.A., S.J.)
| | - Caroline Cayer
- Centre de recherche du CHUS, Centre intégré Universitaire de Santé et des Services Sociaux de l'Estrie, Sherbrooke, QC, Canada (C.C.)
| | - Stephen J Phillips
- Queen Elizabeth Health Sciences Centre, Halifax, NS, Canada (G.J.G., S.J.P., A. Shoamanesh)
| | | | - Ashkan Shoamanesh
- Queen Elizabeth Health Sciences Centre, Halifax, NS, Canada (G.J.G., S.J.P., A. Shoamanesh)
| | - Suresh Subramaniam
- Department of Clinical Neurosciences (T.T.S., A.A., M.A.A., S.B.C., A.M.D., S.S., F. Benali, I.A., M.H., M.D.H., A. Sehgal, Q.Z., C.D., C.K., B.K.M.), Cumming School of Medicine, University of Calgary, AB, Canada
| | - Mahesh P Kate
- Division of Neurology, Department of Medicine, University of Alberta, Edmonton, Canada (S.T., S.M.M., M.P.K., B.H.B.)
| | - Gregory Jacquin
- Département of Neurosciences, Université de Montréal, QC, Canada (Y.D., L.C.G., G.J., A.Y.P.)
- Centre Hospitalier de l'Université de Montréal, QC, Canada (Y.D., L.C.G., G.J., A.Y.P.)
| | - Marie-Christine Camden
- Enfant-Jésus Hospital, Centre Hospitalier Universitaire de Québec, Laval University, Canada (M.-C.C.)
| | - Faysal Benali
- Department of Clinical Neurosciences (T.T.S., A.A., M.A.A., S.B.C., A.M.D., S.S., F. Benali, I.A., M.H., M.D.H., A. Sehgal, Q.Z., C.D., C.K., B.K.M.), Cumming School of Medicine, University of Calgary, AB, Canada
| | - Ibrahim Alhabli
- Department of Clinical Neurosciences (T.T.S., A.A., M.A.A., S.B.C., A.M.D., S.S., F. Benali, I.A., M.H., M.D.H., A. Sehgal, Q.Z., C.D., C.K., B.K.M.), Cumming School of Medicine, University of Calgary, AB, Canada
| | - MacKenzie Horn
- Department of Clinical Neurosciences (T.T.S., A.A., M.A.A., S.B.C., A.M.D., S.S., F. Benali, I.A., M.H., M.D.H., A. Sehgal, Q.Z., C.D., C.K., B.K.M.), Cumming School of Medicine, University of Calgary, AB, Canada
| | - Grant Stotts
- Department of Medicine, University of British Columbia & Fraser Health Authority, New Westminster, BC, Canada (G.M., G.S.)
- University of British Columbia, Fraser Health Authority, New Westminster, BC, Canada (G.M., G.S.)
| | - Michael D Hill
- Department of Community Health Sciences, University of Calgary, AB, Canada (T.T.S., O.I.A., A.A., M.A.A., S.B.C., A.M.D., M.D.H., B.L., B.K.M.)
- Department of Clinical Neurosciences (T.T.S., A.A., M.A.A., S.B.C., A.M.D., S.S., F. Benali, I.A., M.H., M.D.H., A. Sehgal, Q.Z., C.D., C.K., B.K.M.), Cumming School of Medicine, University of Calgary, AB, Canada
- Department of Radiology (M.A.A., S.B.C., A.M.D., M.D.H., B.K.M.), Cumming School of Medicine, University of Calgary, AB, Canada
- Hotchkiss Brain Institute, Calgary, AB, Canada (M.A.A., S.B.C., A.M.D., M.D.H., B.K.M.)
| | - David J Gladstone
- Division of Neurology, Department of Medicine, Hurvitz Brain Sciences Program, Sunnybrook Health Sciences Centre, University of Toronto, ON, Canada (H.K., D.J.G., R.H.S.)
| | - Alexandre Y Poppe
- Département of Neurosciences, Université de Montréal, QC, Canada (Y.D., L.C.G., G.J., A.Y.P.)
- Centre Hospitalier de l'Université de Montréal, QC, Canada (Y.D., L.C.G., G.J., A.Y.P.)
| | - Arshia Sehgal
- Department of Clinical Neurosciences (T.T.S., A.A., M.A.A., S.B.C., A.M.D., S.S., F. Benali, I.A., M.H., M.D.H., A. Sehgal, Q.Z., C.D., C.K., B.K.M.), Cumming School of Medicine, University of Calgary, AB, Canada
| | - Qiao Zhang
- Department of Clinical Neurosciences (T.T.S., A.A., M.A.A., S.B.C., A.M.D., S.S., F. Benali, I.A., M.H., M.D.H., A. Sehgal, Q.Z., C.D., C.K., B.K.M.), Cumming School of Medicine, University of Calgary, AB, Canada
| | - Brendan Lethebe
- Department of Community Health Sciences, University of Calgary, AB, Canada (T.T.S., O.I.A., A.A., M.A.A., S.B.C., A.M.D., M.D.H., B.L., B.K.M.)
| | - Craig Doram
- Department of Clinical Neurosciences (T.T.S., A.A., M.A.A., S.B.C., A.M.D., S.S., F. Benali, I.A., M.H., M.D.H., A. Sehgal, Q.Z., C.D., C.K., B.K.M.), Cumming School of Medicine, University of Calgary, AB, Canada
| | - Michel Shamy
- Department of Medicine, Ottawa Heart Research Institute, University of Ottawa, ON, Canada (D.D., M. Shamy)
| | - Carol Kenney
- Department of Clinical Neurosciences (T.T.S., A.A., M.A.A., S.B.C., A.M.D., S.S., F. Benali, I.A., M.H., M.D.H., A. Sehgal, Q.Z., C.D., C.K., B.K.M.), Cumming School of Medicine, University of Calgary, AB, Canada
| | - Brian H Buck
- Division of Neurology, Department of Medicine, University of Alberta, Edmonton, Canada (S.T., S.M.M., M.P.K., B.H.B.)
| | - Richard H Swartz
- Division of Neurology, Department of Medicine, Hurvitz Brain Sciences Program, Sunnybrook Health Sciences Centre, University of Toronto, ON, Canada (H.K., D.J.G., R.H.S.)
| | - Bijoy K Menon
- Department of Community Health Sciences, University of Calgary, AB, Canada (T.T.S., O.I.A., A.A., M.A.A., S.B.C., A.M.D., M.D.H., B.L., B.K.M.)
- Department of Clinical Neurosciences (T.T.S., A.A., M.A.A., S.B.C., A.M.D., S.S., F. Benali, I.A., M.H., M.D.H., A. Sehgal, Q.Z., C.D., C.K., B.K.M.), Cumming School of Medicine, University of Calgary, AB, Canada
- Department of Radiology (M.A.A., S.B.C., A.M.D., M.D.H., B.K.M.), Cumming School of Medicine, University of Calgary, AB, Canada
- Hotchkiss Brain Institute, Calgary, AB, Canada (M.A.A., S.B.C., A.M.D., M.D.H., B.K.M.)
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Oosterveer DM, van Meijeren-Pont W, van Markus-Doornbosch F, Stegeman E, Terwee CB, Ribbers GM, Vliet Vlieland TP. Translation and cross-cultural adaptation of the ICHOM standard set for stroke: the Dutch version. J Patient Rep Outcomes 2023; 7:91. [PMID: 37695409 PMCID: PMC10495300 DOI: 10.1186/s41687-023-00630-7] [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: 06/02/2023] [Accepted: 08/28/2023] [Indexed: 09/12/2023] Open
Abstract
INTRODUCTION The International Consortium for Health Outcomes Measurement (ICHOM) developed a standard set of patient-centered outcome measures for use in stroke patients. In addition to the Patient-Reported Outcomes Measurement Information System (PROMIS) Global Health, it is comprised of 25 questions that are not part of a specific questionnaire. This study aimed to translate these 25 single questions into Dutch. METHODS Two native Dutch-speaking translators independently translated the original ICHOM questions into Dutch. A consensus translation was made by these translators and a third person. This translation was subsequently translated back to English independently by two native English-speaking translators. Afterwards a pre-final version was made by consensus of a committee. After field-testing among 30 stroke patients, a final version was made. RESULTS The forward and backward translations led to eight cross-cultural adaptations. Based on the interviews with stroke patients, 12 questions were changed to enhance comprehensibility leading to a final Dutch translation of the 25 single questions. CONCLUSIONS A Dutch translation of the 25 single questions of the ICHOM Standard Set for Stroke was developed. Now a complete ICHOM Standard Set for Stroke can be used in Dutch populations allowing comparison and improvement of stroke care.
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Affiliation(s)
- Daniëlla M Oosterveer
- Basalt, Wassenaarseweg 501, 2333 AL, Leiden/The Hague, The Netherlands.
- Department of Orthopaedics, Rehabilitation and Physical Therapy, Leiden University Medical Center, Leiden, The Netherlands.
- Alrijne, Department of Rehabilitation Medicine, Leiden, The Netherlands.
| | - Winke van Meijeren-Pont
- Basalt, Wassenaarseweg 501, 2333 AL, Leiden/The Hague, The Netherlands
- Department of Orthopaedics, Rehabilitation and Physical Therapy, Leiden University Medical Center, Leiden, The Netherlands
| | - Frederike van Markus-Doornbosch
- Basalt, Wassenaarseweg 501, 2333 AL, Leiden/The Hague, The Netherlands
- Department of Orthopaedics, Rehabilitation and Physical Therapy, Leiden University Medical Center, Leiden, The Netherlands
| | - Etienne Stegeman
- Basalt, Wassenaarseweg 501, 2333 AL, Leiden/The Hague, The Netherlands
| | - Caroline B Terwee
- Department of Epidemiology and Data Science, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute - Methodology, Amsterdam, The Netherlands
| | - Gerard M Ribbers
- Department of Rehabilitation, Erasmus University Medical Center, Rotterdam, The Netherlands
- Rijndam Rehabilitation Center, Rotterdam, The Netherlands
| | - Thea Pm Vliet Vlieland
- Basalt, Wassenaarseweg 501, 2333 AL, Leiden/The Hague, The Netherlands
- Department of Orthopaedics, Rehabilitation and Physical Therapy, Leiden University Medical Center, Leiden, The Netherlands
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Ziegeler B, D' Souza W, Vinton A, Mulukutla S, Shaw C, Carne R. Neurological Health: Not Merely the Absence of Disease: Current Wellbeing Instruments Across the Spectrum of Neurology. Am J Lifestyle Med 2023; 17:299-316. [PMID: 36896041 PMCID: PMC9989493 DOI: 10.1177/15598276221086584] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE Well-being and quality of life can vary independently of disease. Instruments measuring well-being and quality of life are commonly used in neurology, but there has been little investigation into the extent in which they accurately measure wellbeing/quality of life or if they merely reflect a diseased state of an individual. DESIGN Systematic searches, thematic analysis and narrative synthesis were undertaken. Individual items from instruments represented in ≥ 5 publications were categorised independently, without prior training, by five neurologists and one well-being researcher, as relating to 'disease-effect' or 'Well-being' with a study-created instrument. Items were additionally categorised into well-being domains. DATA SOURCES MEDLINE, EMBASE, EMCARE and PsycINFO from 1990 to 2020 were performed, across the 13 most prevalent neurological diseases. RESULTS 301 unique instruments were identified. Multiple sclerosis had most unique instruments at 92. SF-36 was used most, in 66 studies. 22 instruments appeared in ≥ 5 publications: 19/22 'well-being' outcome instruments predominantly measured disease effect (Fleiss kappa = .60). Only 1/22 instruments was categorised unanimously as relating to well-being. Instruments predominantly measured mental, physical and activity domains, over social or spiritual. CONCLUSIONS Most neurological well-being or quality-of-life instruments predominantly measure disease effect, rather than disease-independent well-being. Instruments differed widely in well-being domains examined.
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Affiliation(s)
| | | | | | | | - Cameron Shaw
- University Hospital Geelong, Deakin University, Geelong, VIC, Australia
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Jensen M, Sehner S, Cheng B, Schlemm E, Quandt F, Barow E, Wegscheider K, Boutitie F, Ebinger M, Endres M, Fiebach JB, Thijs V, Lemmens R, Muir KW, Nighoghossian N, Pedraza S, Simonsen CZ, Thomalla G, Gerloff C. Patient-Reported Quality of Life After Intravenous Alteplase for Stroke in the WAKE-UP Trial. Neurology 2023; 100:e154-e162. [PMID: 36302662 DOI: 10.1212/wnl.0000000000201375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 08/23/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Intravenous alteplase improves functional outcome after acute ischemic stroke. However, little is known about the effects on self-reported health-related quality of life (HRQoL). METHODS WAKE-UP was a multicenter, randomized, placebo-controlled trial of MRI-guided intravenous alteplase in stroke with unknown onset time. HRQoL was assessed using the EuroQol five-dimensional questionnaire (EQ-5D) at 90 days, comprising the EQ-5D index and the EQ visual analogue scale (VAS). Functional outcome was assessed by the modified Rankin Scale (mRS). We calculated the effect of treatment on EQ-5D index and EQ VAS using multiple linear regression models. Mediation analysis was performed on stroke survivors to explore the extent to which the effect of alteplase on HRQoL was mediated by functional outcome. RESULTS Among 490 stroke survivors, the EQ-5D index was available for 452 (92.2%), of whom 226 (50%) were assigned to treatment with alteplase and 226 (50%) to placebo. At 90 days, mean EQ-5D index was higher, reflecting a better health state, in patients randomized to treatment with alteplase than with placebo (0.75 vs 0.67) with an adjusted mean difference of 0.07 (95% CI 0.02-0.12, p = 0.005). In addition, mean EQ VAS was higher with alteplase than with placebo (72.6 vs 64.9), with an adjusted mean difference of 7.6 (95% CI 3.9-11.8, p < 0.001). Eighty-five percent of the total treatment effect of alteplase on the EQ-5D index was mediated using the mRS score while there was no significant direct effect. By contrast, the treatment effect on the EQ VAS was mainly through the direct pathway (60%), whereas 40% was mediated by the mRS. DISCUSSION Assessment of patient-reported outcome measures reveals a potential benefit of intravenous alteplase for HRQoL beyond improvement of functional outcome. TRIAL REGISTRATION INFORMATION ClinicalTrials.gov number, NCT01525290; EudraCT number, 2011-005906-32.
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Affiliation(s)
- Märit Jensen
- From the Klinik und Poliklinik für Neurologie (M.J., B.C., E.S., F.Q., E.B., G.T., C.G.), Kopf- und Neurozentrum, University Medical Center Hamburg-Eppendorf; Institut für Medizinische Biometrie und Epidemiologie (S.S., K.W.), Zentrum für Experimentelle Medizin, Universitätsklinikum Hamburg-Eppendorf, Germany; Hospices Civils de Lyon (F.B.), Service de Biostatistique; Université Lyon 1 (F.B.), Villeurbanne; and CNRS (F.B.), UMR 5558, Laboratoire de Biométrie et Biologie Evolutive, Villeurbanne, France; Centrum für Schlaganfallforschung Berlin (CSB) (M. Ebinger, M. Endres, J.F.) and Klinik und Hochschulambulanz für Neurologie (M. Endres), Charité-Universitätsmedizin Berlin; Neurologie (M. Ebinger), Medical Park Berlin Humboldtmühle; German Center for Neurodegenerative Disease (DZNE) (M. Endres), Partner Site Berlin; German Center for Cardiovascular Research (DZHK) (M. Endres), Partner Site Berlin; Excellence Cluster NeuroCure (M. Endres), Berlin, Germany; Florey Institute of Neuroscience and Mental Health (V.T.), University of Melbourne, Heidelberg, Victoria Department of Neurology (V.T.), Austin Health, Heidelberg, Victoria, Australia; Department of Neurology (R.L.), University Hospitals Leuven; Department of Neurosciences (R.L.), KU Leuven, University of Leuven, Experimental Neurology; VIB (R.L.), Center for Brain & Disease Research, Laboratory of Neurobiology, Leuven, Belgium; School of Psychology & Neuroscience (K.M.), University of Glasgow, United Kingdom; Department of Stroke Medicine (N.N.), Université Claude Bernard Lyon 1, CREATIS CNRS UMR 5220-INSERM U1206, INSA; Hospices Civils de Lyon (N.N.), France; Department of Radiology (S.P.), Institut de Diagnostic per la Image (IDI), Hospital Dr Josep Trueta, Institut dInvestigació Biomèdica de Girona (IDIBGI), Girona, Spain; and Department of Neurology (C.Z.S.), Aarhus University Hospital, Denmark.
| | - Susanne Sehner
- From the Klinik und Poliklinik für Neurologie (M.J., B.C., E.S., F.Q., E.B., G.T., C.G.), Kopf- und Neurozentrum, University Medical Center Hamburg-Eppendorf; Institut für Medizinische Biometrie und Epidemiologie (S.S., K.W.), Zentrum für Experimentelle Medizin, Universitätsklinikum Hamburg-Eppendorf, Germany; Hospices Civils de Lyon (F.B.), Service de Biostatistique; Université Lyon 1 (F.B.), Villeurbanne; and CNRS (F.B.), UMR 5558, Laboratoire de Biométrie et Biologie Evolutive, Villeurbanne, France; Centrum für Schlaganfallforschung Berlin (CSB) (M. Ebinger, M. Endres, J.F.) and Klinik und Hochschulambulanz für Neurologie (M. Endres), Charité-Universitätsmedizin Berlin; Neurologie (M. Ebinger), Medical Park Berlin Humboldtmühle; German Center for Neurodegenerative Disease (DZNE) (M. Endres), Partner Site Berlin; German Center for Cardiovascular Research (DZHK) (M. Endres), Partner Site Berlin; Excellence Cluster NeuroCure (M. Endres), Berlin, Germany; Florey Institute of Neuroscience and Mental Health (V.T.), University of Melbourne, Heidelberg, Victoria Department of Neurology (V.T.), Austin Health, Heidelberg, Victoria, Australia; Department of Neurology (R.L.), University Hospitals Leuven; Department of Neurosciences (R.L.), KU Leuven, University of Leuven, Experimental Neurology; VIB (R.L.), Center for Brain & Disease Research, Laboratory of Neurobiology, Leuven, Belgium; School of Psychology & Neuroscience (K.M.), University of Glasgow, United Kingdom; Department of Stroke Medicine (N.N.), Université Claude Bernard Lyon 1, CREATIS CNRS UMR 5220-INSERM U1206, INSA; Hospices Civils de Lyon (N.N.), France; Department of Radiology (S.P.), Institut de Diagnostic per la Image (IDI), Hospital Dr Josep Trueta, Institut dInvestigació Biomèdica de Girona (IDIBGI), Girona, Spain; and Department of Neurology (C.Z.S.), Aarhus University Hospital, Denmark
| | - Bastian Cheng
- From the Klinik und Poliklinik für Neurologie (M.J., B.C., E.S., F.Q., E.B., G.T., C.G.), Kopf- und Neurozentrum, University Medical Center Hamburg-Eppendorf; Institut für Medizinische Biometrie und Epidemiologie (S.S., K.W.), Zentrum für Experimentelle Medizin, Universitätsklinikum Hamburg-Eppendorf, Germany; Hospices Civils de Lyon (F.B.), Service de Biostatistique; Université Lyon 1 (F.B.), Villeurbanne; and CNRS (F.B.), UMR 5558, Laboratoire de Biométrie et Biologie Evolutive, Villeurbanne, France; Centrum für Schlaganfallforschung Berlin (CSB) (M. Ebinger, M. Endres, J.F.) and Klinik und Hochschulambulanz für Neurologie (M. Endres), Charité-Universitätsmedizin Berlin; Neurologie (M. Ebinger), Medical Park Berlin Humboldtmühle; German Center for Neurodegenerative Disease (DZNE) (M. Endres), Partner Site Berlin; German Center for Cardiovascular Research (DZHK) (M. Endres), Partner Site Berlin; Excellence Cluster NeuroCure (M. Endres), Berlin, Germany; Florey Institute of Neuroscience and Mental Health (V.T.), University of Melbourne, Heidelberg, Victoria Department of Neurology (V.T.), Austin Health, Heidelberg, Victoria, Australia; Department of Neurology (R.L.), University Hospitals Leuven; Department of Neurosciences (R.L.), KU Leuven, University of Leuven, Experimental Neurology; VIB (R.L.), Center for Brain & Disease Research, Laboratory of Neurobiology, Leuven, Belgium; School of Psychology & Neuroscience (K.M.), University of Glasgow, United Kingdom; Department of Stroke Medicine (N.N.), Université Claude Bernard Lyon 1, CREATIS CNRS UMR 5220-INSERM U1206, INSA; Hospices Civils de Lyon (N.N.), France; Department of Radiology (S.P.), Institut de Diagnostic per la Image (IDI), Hospital Dr Josep Trueta, Institut dInvestigació Biomèdica de Girona (IDIBGI), Girona, Spain; and Department of Neurology (C.Z.S.), Aarhus University Hospital, Denmark
| | - Eckhard Schlemm
- From the Klinik und Poliklinik für Neurologie (M.J., B.C., E.S., F.Q., E.B., G.T., C.G.), Kopf- und Neurozentrum, University Medical Center Hamburg-Eppendorf; Institut für Medizinische Biometrie und Epidemiologie (S.S., K.W.), Zentrum für Experimentelle Medizin, Universitätsklinikum Hamburg-Eppendorf, Germany; Hospices Civils de Lyon (F.B.), Service de Biostatistique; Université Lyon 1 (F.B.), Villeurbanne; and CNRS (F.B.), UMR 5558, Laboratoire de Biométrie et Biologie Evolutive, Villeurbanne, France; Centrum für Schlaganfallforschung Berlin (CSB) (M. Ebinger, M. Endres, J.F.) and Klinik und Hochschulambulanz für Neurologie (M. Endres), Charité-Universitätsmedizin Berlin; Neurologie (M. Ebinger), Medical Park Berlin Humboldtmühle; German Center for Neurodegenerative Disease (DZNE) (M. Endres), Partner Site Berlin; German Center for Cardiovascular Research (DZHK) (M. Endres), Partner Site Berlin; Excellence Cluster NeuroCure (M. Endres), Berlin, Germany; Florey Institute of Neuroscience and Mental Health (V.T.), University of Melbourne, Heidelberg, Victoria Department of Neurology (V.T.), Austin Health, Heidelberg, Victoria, Australia; Department of Neurology (R.L.), University Hospitals Leuven; Department of Neurosciences (R.L.), KU Leuven, University of Leuven, Experimental Neurology; VIB (R.L.), Center for Brain & Disease Research, Laboratory of Neurobiology, Leuven, Belgium; School of Psychology & Neuroscience (K.M.), University of Glasgow, United Kingdom; Department of Stroke Medicine (N.N.), Université Claude Bernard Lyon 1, CREATIS CNRS UMR 5220-INSERM U1206, INSA; Hospices Civils de Lyon (N.N.), France; Department of Radiology (S.P.), Institut de Diagnostic per la Image (IDI), Hospital Dr Josep Trueta, Institut dInvestigació Biomèdica de Girona (IDIBGI), Girona, Spain; and Department of Neurology (C.Z.S.), Aarhus University Hospital, Denmark
| | - Fanny Quandt
- From the Klinik und Poliklinik für Neurologie (M.J., B.C., E.S., F.Q., E.B., G.T., C.G.), Kopf- und Neurozentrum, University Medical Center Hamburg-Eppendorf; Institut für Medizinische Biometrie und Epidemiologie (S.S., K.W.), Zentrum für Experimentelle Medizin, Universitätsklinikum Hamburg-Eppendorf, Germany; Hospices Civils de Lyon (F.B.), Service de Biostatistique; Université Lyon 1 (F.B.), Villeurbanne; and CNRS (F.B.), UMR 5558, Laboratoire de Biométrie et Biologie Evolutive, Villeurbanne, France; Centrum für Schlaganfallforschung Berlin (CSB) (M. Ebinger, M. Endres, J.F.) and Klinik und Hochschulambulanz für Neurologie (M. Endres), Charité-Universitätsmedizin Berlin; Neurologie (M. Ebinger), Medical Park Berlin Humboldtmühle; German Center for Neurodegenerative Disease (DZNE) (M. Endres), Partner Site Berlin; German Center for Cardiovascular Research (DZHK) (M. Endres), Partner Site Berlin; Excellence Cluster NeuroCure (M. Endres), Berlin, Germany; Florey Institute of Neuroscience and Mental Health (V.T.), University of Melbourne, Heidelberg, Victoria Department of Neurology (V.T.), Austin Health, Heidelberg, Victoria, Australia; Department of Neurology (R.L.), University Hospitals Leuven; Department of Neurosciences (R.L.), KU Leuven, University of Leuven, Experimental Neurology; VIB (R.L.), Center for Brain & Disease Research, Laboratory of Neurobiology, Leuven, Belgium; School of Psychology & Neuroscience (K.M.), University of Glasgow, United Kingdom; Department of Stroke Medicine (N.N.), Université Claude Bernard Lyon 1, CREATIS CNRS UMR 5220-INSERM U1206, INSA; Hospices Civils de Lyon (N.N.), France; Department of Radiology (S.P.), Institut de Diagnostic per la Image (IDI), Hospital Dr Josep Trueta, Institut dInvestigació Biomèdica de Girona (IDIBGI), Girona, Spain; and Department of Neurology (C.Z.S.), Aarhus University Hospital, Denmark
| | - Ewgenia Barow
- From the Klinik und Poliklinik für Neurologie (M.J., B.C., E.S., F.Q., E.B., G.T., C.G.), Kopf- und Neurozentrum, University Medical Center Hamburg-Eppendorf; Institut für Medizinische Biometrie und Epidemiologie (S.S., K.W.), Zentrum für Experimentelle Medizin, Universitätsklinikum Hamburg-Eppendorf, Germany; Hospices Civils de Lyon (F.B.), Service de Biostatistique; Université Lyon 1 (F.B.), Villeurbanne; and CNRS (F.B.), UMR 5558, Laboratoire de Biométrie et Biologie Evolutive, Villeurbanne, France; Centrum für Schlaganfallforschung Berlin (CSB) (M. Ebinger, M. Endres, J.F.) and Klinik und Hochschulambulanz für Neurologie (M. Endres), Charité-Universitätsmedizin Berlin; Neurologie (M. Ebinger), Medical Park Berlin Humboldtmühle; German Center for Neurodegenerative Disease (DZNE) (M. Endres), Partner Site Berlin; German Center for Cardiovascular Research (DZHK) (M. Endres), Partner Site Berlin; Excellence Cluster NeuroCure (M. Endres), Berlin, Germany; Florey Institute of Neuroscience and Mental Health (V.T.), University of Melbourne, Heidelberg, Victoria Department of Neurology (V.T.), Austin Health, Heidelberg, Victoria, Australia; Department of Neurology (R.L.), University Hospitals Leuven; Department of Neurosciences (R.L.), KU Leuven, University of Leuven, Experimental Neurology; VIB (R.L.), Center for Brain & Disease Research, Laboratory of Neurobiology, Leuven, Belgium; School of Psychology & Neuroscience (K.M.), University of Glasgow, United Kingdom; Department of Stroke Medicine (N.N.), Université Claude Bernard Lyon 1, CREATIS CNRS UMR 5220-INSERM U1206, INSA; Hospices Civils de Lyon (N.N.), France; Department of Radiology (S.P.), Institut de Diagnostic per la Image (IDI), Hospital Dr Josep Trueta, Institut dInvestigació Biomèdica de Girona (IDIBGI), Girona, Spain; and Department of Neurology (C.Z.S.), Aarhus University Hospital, Denmark
| | - Karl Wegscheider
- From the Klinik und Poliklinik für Neurologie (M.J., B.C., E.S., F.Q., E.B., G.T., C.G.), Kopf- und Neurozentrum, University Medical Center Hamburg-Eppendorf; Institut für Medizinische Biometrie und Epidemiologie (S.S., K.W.), Zentrum für Experimentelle Medizin, Universitätsklinikum Hamburg-Eppendorf, Germany; Hospices Civils de Lyon (F.B.), Service de Biostatistique; Université Lyon 1 (F.B.), Villeurbanne; and CNRS (F.B.), UMR 5558, Laboratoire de Biométrie et Biologie Evolutive, Villeurbanne, France; Centrum für Schlaganfallforschung Berlin (CSB) (M. Ebinger, M. Endres, J.F.) and Klinik und Hochschulambulanz für Neurologie (M. Endres), Charité-Universitätsmedizin Berlin; Neurologie (M. Ebinger), Medical Park Berlin Humboldtmühle; German Center for Neurodegenerative Disease (DZNE) (M. Endres), Partner Site Berlin; German Center for Cardiovascular Research (DZHK) (M. Endres), Partner Site Berlin; Excellence Cluster NeuroCure (M. Endres), Berlin, Germany; Florey Institute of Neuroscience and Mental Health (V.T.), University of Melbourne, Heidelberg, Victoria Department of Neurology (V.T.), Austin Health, Heidelberg, Victoria, Australia; Department of Neurology (R.L.), University Hospitals Leuven; Department of Neurosciences (R.L.), KU Leuven, University of Leuven, Experimental Neurology; VIB (R.L.), Center for Brain & Disease Research, Laboratory of Neurobiology, Leuven, Belgium; School of Psychology & Neuroscience (K.M.), University of Glasgow, United Kingdom; Department of Stroke Medicine (N.N.), Université Claude Bernard Lyon 1, CREATIS CNRS UMR 5220-INSERM U1206, INSA; Hospices Civils de Lyon (N.N.), France; Department of Radiology (S.P.), Institut de Diagnostic per la Image (IDI), Hospital Dr Josep Trueta, Institut dInvestigació Biomèdica de Girona (IDIBGI), Girona, Spain; and Department of Neurology (C.Z.S.), Aarhus University Hospital, Denmark
| | - Florent Boutitie
- From the Klinik und Poliklinik für Neurologie (M.J., B.C., E.S., F.Q., E.B., G.T., C.G.), Kopf- und Neurozentrum, University Medical Center Hamburg-Eppendorf; Institut für Medizinische Biometrie und Epidemiologie (S.S., K.W.), Zentrum für Experimentelle Medizin, Universitätsklinikum Hamburg-Eppendorf, Germany; Hospices Civils de Lyon (F.B.), Service de Biostatistique; Université Lyon 1 (F.B.), Villeurbanne; and CNRS (F.B.), UMR 5558, Laboratoire de Biométrie et Biologie Evolutive, Villeurbanne, France; Centrum für Schlaganfallforschung Berlin (CSB) (M. Ebinger, M. Endres, J.F.) and Klinik und Hochschulambulanz für Neurologie (M. Endres), Charité-Universitätsmedizin Berlin; Neurologie (M. Ebinger), Medical Park Berlin Humboldtmühle; German Center for Neurodegenerative Disease (DZNE) (M. Endres), Partner Site Berlin; German Center for Cardiovascular Research (DZHK) (M. Endres), Partner Site Berlin; Excellence Cluster NeuroCure (M. Endres), Berlin, Germany; Florey Institute of Neuroscience and Mental Health (V.T.), University of Melbourne, Heidelberg, Victoria Department of Neurology (V.T.), Austin Health, Heidelberg, Victoria, Australia; Department of Neurology (R.L.), University Hospitals Leuven; Department of Neurosciences (R.L.), KU Leuven, University of Leuven, Experimental Neurology; VIB (R.L.), Center for Brain & Disease Research, Laboratory of Neurobiology, Leuven, Belgium; School of Psychology & Neuroscience (K.M.), University of Glasgow, United Kingdom; Department of Stroke Medicine (N.N.), Université Claude Bernard Lyon 1, CREATIS CNRS UMR 5220-INSERM U1206, INSA; Hospices Civils de Lyon (N.N.), France; Department of Radiology (S.P.), Institut de Diagnostic per la Image (IDI), Hospital Dr Josep Trueta, Institut dInvestigació Biomèdica de Girona (IDIBGI), Girona, Spain; and Department of Neurology (C.Z.S.), Aarhus University Hospital, Denmark
| | - Martin Ebinger
- From the Klinik und Poliklinik für Neurologie (M.J., B.C., E.S., F.Q., E.B., G.T., C.G.), Kopf- und Neurozentrum, University Medical Center Hamburg-Eppendorf; Institut für Medizinische Biometrie und Epidemiologie (S.S., K.W.), Zentrum für Experimentelle Medizin, Universitätsklinikum Hamburg-Eppendorf, Germany; Hospices Civils de Lyon (F.B.), Service de Biostatistique; Université Lyon 1 (F.B.), Villeurbanne; and CNRS (F.B.), UMR 5558, Laboratoire de Biométrie et Biologie Evolutive, Villeurbanne, France; Centrum für Schlaganfallforschung Berlin (CSB) (M. Ebinger, M. Endres, J.F.) and Klinik und Hochschulambulanz für Neurologie (M. Endres), Charité-Universitätsmedizin Berlin; Neurologie (M. Ebinger), Medical Park Berlin Humboldtmühle; German Center for Neurodegenerative Disease (DZNE) (M. Endres), Partner Site Berlin; German Center for Cardiovascular Research (DZHK) (M. Endres), Partner Site Berlin; Excellence Cluster NeuroCure (M. Endres), Berlin, Germany; Florey Institute of Neuroscience and Mental Health (V.T.), University of Melbourne, Heidelberg, Victoria Department of Neurology (V.T.), Austin Health, Heidelberg, Victoria, Australia; Department of Neurology (R.L.), University Hospitals Leuven; Department of Neurosciences (R.L.), KU Leuven, University of Leuven, Experimental Neurology; VIB (R.L.), Center for Brain & Disease Research, Laboratory of Neurobiology, Leuven, Belgium; School of Psychology & Neuroscience (K.M.), University of Glasgow, United Kingdom; Department of Stroke Medicine (N.N.), Université Claude Bernard Lyon 1, CREATIS CNRS UMR 5220-INSERM U1206, INSA; Hospices Civils de Lyon (N.N.), France; Department of Radiology (S.P.), Institut de Diagnostic per la Image (IDI), Hospital Dr Josep Trueta, Institut dInvestigació Biomèdica de Girona (IDIBGI), Girona, Spain; and Department of Neurology (C.Z.S.), Aarhus University Hospital, Denmark
| | - Matthias Endres
- From the Klinik und Poliklinik für Neurologie (M.J., B.C., E.S., F.Q., E.B., G.T., C.G.), Kopf- und Neurozentrum, University Medical Center Hamburg-Eppendorf; Institut für Medizinische Biometrie und Epidemiologie (S.S., K.W.), Zentrum für Experimentelle Medizin, Universitätsklinikum Hamburg-Eppendorf, Germany; Hospices Civils de Lyon (F.B.), Service de Biostatistique; Université Lyon 1 (F.B.), Villeurbanne; and CNRS (F.B.), UMR 5558, Laboratoire de Biométrie et Biologie Evolutive, Villeurbanne, France; Centrum für Schlaganfallforschung Berlin (CSB) (M. Ebinger, M. Endres, J.F.) and Klinik und Hochschulambulanz für Neurologie (M. Endres), Charité-Universitätsmedizin Berlin; Neurologie (M. Ebinger), Medical Park Berlin Humboldtmühle; German Center for Neurodegenerative Disease (DZNE) (M. Endres), Partner Site Berlin; German Center for Cardiovascular Research (DZHK) (M. Endres), Partner Site Berlin; Excellence Cluster NeuroCure (M. Endres), Berlin, Germany; Florey Institute of Neuroscience and Mental Health (V.T.), University of Melbourne, Heidelberg, Victoria Department of Neurology (V.T.), Austin Health, Heidelberg, Victoria, Australia; Department of Neurology (R.L.), University Hospitals Leuven; Department of Neurosciences (R.L.), KU Leuven, University of Leuven, Experimental Neurology; VIB (R.L.), Center for Brain & Disease Research, Laboratory of Neurobiology, Leuven, Belgium; School of Psychology & Neuroscience (K.M.), University of Glasgow, United Kingdom; Department of Stroke Medicine (N.N.), Université Claude Bernard Lyon 1, CREATIS CNRS UMR 5220-INSERM U1206, INSA; Hospices Civils de Lyon (N.N.), France; Department of Radiology (S.P.), Institut de Diagnostic per la Image (IDI), Hospital Dr Josep Trueta, Institut dInvestigació Biomèdica de Girona (IDIBGI), Girona, Spain; and Department of Neurology (C.Z.S.), Aarhus University Hospital, Denmark
| | - Jochen B Fiebach
- From the Klinik und Poliklinik für Neurologie (M.J., B.C., E.S., F.Q., E.B., G.T., C.G.), Kopf- und Neurozentrum, University Medical Center Hamburg-Eppendorf; Institut für Medizinische Biometrie und Epidemiologie (S.S., K.W.), Zentrum für Experimentelle Medizin, Universitätsklinikum Hamburg-Eppendorf, Germany; Hospices Civils de Lyon (F.B.), Service de Biostatistique; Université Lyon 1 (F.B.), Villeurbanne; and CNRS (F.B.), UMR 5558, Laboratoire de Biométrie et Biologie Evolutive, Villeurbanne, France; Centrum für Schlaganfallforschung Berlin (CSB) (M. Ebinger, M. Endres, J.F.) and Klinik und Hochschulambulanz für Neurologie (M. Endres), Charité-Universitätsmedizin Berlin; Neurologie (M. Ebinger), Medical Park Berlin Humboldtmühle; German Center for Neurodegenerative Disease (DZNE) (M. Endres), Partner Site Berlin; German Center for Cardiovascular Research (DZHK) (M. Endres), Partner Site Berlin; Excellence Cluster NeuroCure (M. Endres), Berlin, Germany; Florey Institute of Neuroscience and Mental Health (V.T.), University of Melbourne, Heidelberg, Victoria Department of Neurology (V.T.), Austin Health, Heidelberg, Victoria, Australia; Department of Neurology (R.L.), University Hospitals Leuven; Department of Neurosciences (R.L.), KU Leuven, University of Leuven, Experimental Neurology; VIB (R.L.), Center for Brain & Disease Research, Laboratory of Neurobiology, Leuven, Belgium; School of Psychology & Neuroscience (K.M.), University of Glasgow, United Kingdom; Department of Stroke Medicine (N.N.), Université Claude Bernard Lyon 1, CREATIS CNRS UMR 5220-INSERM U1206, INSA; Hospices Civils de Lyon (N.N.), France; Department of Radiology (S.P.), Institut de Diagnostic per la Image (IDI), Hospital Dr Josep Trueta, Institut dInvestigació Biomèdica de Girona (IDIBGI), Girona, Spain; and Department of Neurology (C.Z.S.), Aarhus University Hospital, Denmark
| | - Vincent Thijs
- From the Klinik und Poliklinik für Neurologie (M.J., B.C., E.S., F.Q., E.B., G.T., C.G.), Kopf- und Neurozentrum, University Medical Center Hamburg-Eppendorf; Institut für Medizinische Biometrie und Epidemiologie (S.S., K.W.), Zentrum für Experimentelle Medizin, Universitätsklinikum Hamburg-Eppendorf, Germany; Hospices Civils de Lyon (F.B.), Service de Biostatistique; Université Lyon 1 (F.B.), Villeurbanne; and CNRS (F.B.), UMR 5558, Laboratoire de Biométrie et Biologie Evolutive, Villeurbanne, France; Centrum für Schlaganfallforschung Berlin (CSB) (M. Ebinger, M. Endres, J.F.) and Klinik und Hochschulambulanz für Neurologie (M. Endres), Charité-Universitätsmedizin Berlin; Neurologie (M. Ebinger), Medical Park Berlin Humboldtmühle; German Center for Neurodegenerative Disease (DZNE) (M. Endres), Partner Site Berlin; German Center for Cardiovascular Research (DZHK) (M. Endres), Partner Site Berlin; Excellence Cluster NeuroCure (M. Endres), Berlin, Germany; Florey Institute of Neuroscience and Mental Health (V.T.), University of Melbourne, Heidelberg, Victoria Department of Neurology (V.T.), Austin Health, Heidelberg, Victoria, Australia; Department of Neurology (R.L.), University Hospitals Leuven; Department of Neurosciences (R.L.), KU Leuven, University of Leuven, Experimental Neurology; VIB (R.L.), Center for Brain & Disease Research, Laboratory of Neurobiology, Leuven, Belgium; School of Psychology & Neuroscience (K.M.), University of Glasgow, United Kingdom; Department of Stroke Medicine (N.N.), Université Claude Bernard Lyon 1, CREATIS CNRS UMR 5220-INSERM U1206, INSA; Hospices Civils de Lyon (N.N.), France; Department of Radiology (S.P.), Institut de Diagnostic per la Image (IDI), Hospital Dr Josep Trueta, Institut dInvestigació Biomèdica de Girona (IDIBGI), Girona, Spain; and Department of Neurology (C.Z.S.), Aarhus University Hospital, Denmark
| | - Robin Lemmens
- From the Klinik und Poliklinik für Neurologie (M.J., B.C., E.S., F.Q., E.B., G.T., C.G.), Kopf- und Neurozentrum, University Medical Center Hamburg-Eppendorf; Institut für Medizinische Biometrie und Epidemiologie (S.S., K.W.), Zentrum für Experimentelle Medizin, Universitätsklinikum Hamburg-Eppendorf, Germany; Hospices Civils de Lyon (F.B.), Service de Biostatistique; Université Lyon 1 (F.B.), Villeurbanne; and CNRS (F.B.), UMR 5558, Laboratoire de Biométrie et Biologie Evolutive, Villeurbanne, France; Centrum für Schlaganfallforschung Berlin (CSB) (M. Ebinger, M. Endres, J.F.) and Klinik und Hochschulambulanz für Neurologie (M. Endres), Charité-Universitätsmedizin Berlin; Neurologie (M. Ebinger), Medical Park Berlin Humboldtmühle; German Center for Neurodegenerative Disease (DZNE) (M. Endres), Partner Site Berlin; German Center for Cardiovascular Research (DZHK) (M. Endres), Partner Site Berlin; Excellence Cluster NeuroCure (M. Endres), Berlin, Germany; Florey Institute of Neuroscience and Mental Health (V.T.), University of Melbourne, Heidelberg, Victoria Department of Neurology (V.T.), Austin Health, Heidelberg, Victoria, Australia; Department of Neurology (R.L.), University Hospitals Leuven; Department of Neurosciences (R.L.), KU Leuven, University of Leuven, Experimental Neurology; VIB (R.L.), Center for Brain & Disease Research, Laboratory of Neurobiology, Leuven, Belgium; School of Psychology & Neuroscience (K.M.), University of Glasgow, United Kingdom; Department of Stroke Medicine (N.N.), Université Claude Bernard Lyon 1, CREATIS CNRS UMR 5220-INSERM U1206, INSA; Hospices Civils de Lyon (N.N.), France; Department of Radiology (S.P.), Institut de Diagnostic per la Image (IDI), Hospital Dr Josep Trueta, Institut dInvestigació Biomèdica de Girona (IDIBGI), Girona, Spain; and Department of Neurology (C.Z.S.), Aarhus University Hospital, Denmark
| | - Keith W Muir
- From the Klinik und Poliklinik für Neurologie (M.J., B.C., E.S., F.Q., E.B., G.T., C.G.), Kopf- und Neurozentrum, University Medical Center Hamburg-Eppendorf; Institut für Medizinische Biometrie und Epidemiologie (S.S., K.W.), Zentrum für Experimentelle Medizin, Universitätsklinikum Hamburg-Eppendorf, Germany; Hospices Civils de Lyon (F.B.), Service de Biostatistique; Université Lyon 1 (F.B.), Villeurbanne; and CNRS (F.B.), UMR 5558, Laboratoire de Biométrie et Biologie Evolutive, Villeurbanne, France; Centrum für Schlaganfallforschung Berlin (CSB) (M. Ebinger, M. Endres, J.F.) and Klinik und Hochschulambulanz für Neurologie (M. Endres), Charité-Universitätsmedizin Berlin; Neurologie (M. Ebinger), Medical Park Berlin Humboldtmühle; German Center for Neurodegenerative Disease (DZNE) (M. Endres), Partner Site Berlin; German Center for Cardiovascular Research (DZHK) (M. Endres), Partner Site Berlin; Excellence Cluster NeuroCure (M. Endres), Berlin, Germany; Florey Institute of Neuroscience and Mental Health (V.T.), University of Melbourne, Heidelberg, Victoria Department of Neurology (V.T.), Austin Health, Heidelberg, Victoria, Australia; Department of Neurology (R.L.), University Hospitals Leuven; Department of Neurosciences (R.L.), KU Leuven, University of Leuven, Experimental Neurology; VIB (R.L.), Center for Brain & Disease Research, Laboratory of Neurobiology, Leuven, Belgium; School of Psychology & Neuroscience (K.M.), University of Glasgow, United Kingdom; Department of Stroke Medicine (N.N.), Université Claude Bernard Lyon 1, CREATIS CNRS UMR 5220-INSERM U1206, INSA; Hospices Civils de Lyon (N.N.), France; Department of Radiology (S.P.), Institut de Diagnostic per la Image (IDI), Hospital Dr Josep Trueta, Institut dInvestigació Biomèdica de Girona (IDIBGI), Girona, Spain; and Department of Neurology (C.Z.S.), Aarhus University Hospital, Denmark
| | - Norbert Nighoghossian
- From the Klinik und Poliklinik für Neurologie (M.J., B.C., E.S., F.Q., E.B., G.T., C.G.), Kopf- und Neurozentrum, University Medical Center Hamburg-Eppendorf; Institut für Medizinische Biometrie und Epidemiologie (S.S., K.W.), Zentrum für Experimentelle Medizin, Universitätsklinikum Hamburg-Eppendorf, Germany; Hospices Civils de Lyon (F.B.), Service de Biostatistique; Université Lyon 1 (F.B.), Villeurbanne; and CNRS (F.B.), UMR 5558, Laboratoire de Biométrie et Biologie Evolutive, Villeurbanne, France; Centrum für Schlaganfallforschung Berlin (CSB) (M. Ebinger, M. Endres, J.F.) and Klinik und Hochschulambulanz für Neurologie (M. Endres), Charité-Universitätsmedizin Berlin; Neurologie (M. Ebinger), Medical Park Berlin Humboldtmühle; German Center for Neurodegenerative Disease (DZNE) (M. Endres), Partner Site Berlin; German Center for Cardiovascular Research (DZHK) (M. Endres), Partner Site Berlin; Excellence Cluster NeuroCure (M. Endres), Berlin, Germany; Florey Institute of Neuroscience and Mental Health (V.T.), University of Melbourne, Heidelberg, Victoria Department of Neurology (V.T.), Austin Health, Heidelberg, Victoria, Australia; Department of Neurology (R.L.), University Hospitals Leuven; Department of Neurosciences (R.L.), KU Leuven, University of Leuven, Experimental Neurology; VIB (R.L.), Center for Brain & Disease Research, Laboratory of Neurobiology, Leuven, Belgium; School of Psychology & Neuroscience (K.M.), University of Glasgow, United Kingdom; Department of Stroke Medicine (N.N.), Université Claude Bernard Lyon 1, CREATIS CNRS UMR 5220-INSERM U1206, INSA; Hospices Civils de Lyon (N.N.), France; Department of Radiology (S.P.), Institut de Diagnostic per la Image (IDI), Hospital Dr Josep Trueta, Institut dInvestigació Biomèdica de Girona (IDIBGI), Girona, Spain; and Department of Neurology (C.Z.S.), Aarhus University Hospital, Denmark
| | - Salvador Pedraza
- From the Klinik und Poliklinik für Neurologie (M.J., B.C., E.S., F.Q., E.B., G.T., C.G.), Kopf- und Neurozentrum, University Medical Center Hamburg-Eppendorf; Institut für Medizinische Biometrie und Epidemiologie (S.S., K.W.), Zentrum für Experimentelle Medizin, Universitätsklinikum Hamburg-Eppendorf, Germany; Hospices Civils de Lyon (F.B.), Service de Biostatistique; Université Lyon 1 (F.B.), Villeurbanne; and CNRS (F.B.), UMR 5558, Laboratoire de Biométrie et Biologie Evolutive, Villeurbanne, France; Centrum für Schlaganfallforschung Berlin (CSB) (M. Ebinger, M. Endres, J.F.) and Klinik und Hochschulambulanz für Neurologie (M. Endres), Charité-Universitätsmedizin Berlin; Neurologie (M. Ebinger), Medical Park Berlin Humboldtmühle; German Center for Neurodegenerative Disease (DZNE) (M. Endres), Partner Site Berlin; German Center for Cardiovascular Research (DZHK) (M. Endres), Partner Site Berlin; Excellence Cluster NeuroCure (M. Endres), Berlin, Germany; Florey Institute of Neuroscience and Mental Health (V.T.), University of Melbourne, Heidelberg, Victoria Department of Neurology (V.T.), Austin Health, Heidelberg, Victoria, Australia; Department of Neurology (R.L.), University Hospitals Leuven; Department of Neurosciences (R.L.), KU Leuven, University of Leuven, Experimental Neurology; VIB (R.L.), Center for Brain & Disease Research, Laboratory of Neurobiology, Leuven, Belgium; School of Psychology & Neuroscience (K.M.), University of Glasgow, United Kingdom; Department of Stroke Medicine (N.N.), Université Claude Bernard Lyon 1, CREATIS CNRS UMR 5220-INSERM U1206, INSA; Hospices Civils de Lyon (N.N.), France; Department of Radiology (S.P.), Institut de Diagnostic per la Image (IDI), Hospital Dr Josep Trueta, Institut dInvestigació Biomèdica de Girona (IDIBGI), Girona, Spain; and Department of Neurology (C.Z.S.), Aarhus University Hospital, Denmark
| | - Claus Z Simonsen
- From the Klinik und Poliklinik für Neurologie (M.J., B.C., E.S., F.Q., E.B., G.T., C.G.), Kopf- und Neurozentrum, University Medical Center Hamburg-Eppendorf; Institut für Medizinische Biometrie und Epidemiologie (S.S., K.W.), Zentrum für Experimentelle Medizin, Universitätsklinikum Hamburg-Eppendorf, Germany; Hospices Civils de Lyon (F.B.), Service de Biostatistique; Université Lyon 1 (F.B.), Villeurbanne; and CNRS (F.B.), UMR 5558, Laboratoire de Biométrie et Biologie Evolutive, Villeurbanne, France; Centrum für Schlaganfallforschung Berlin (CSB) (M. Ebinger, M. Endres, J.F.) and Klinik und Hochschulambulanz für Neurologie (M. Endres), Charité-Universitätsmedizin Berlin; Neurologie (M. Ebinger), Medical Park Berlin Humboldtmühle; German Center for Neurodegenerative Disease (DZNE) (M. Endres), Partner Site Berlin; German Center for Cardiovascular Research (DZHK) (M. Endres), Partner Site Berlin; Excellence Cluster NeuroCure (M. Endres), Berlin, Germany; Florey Institute of Neuroscience and Mental Health (V.T.), University of Melbourne, Heidelberg, Victoria Department of Neurology (V.T.), Austin Health, Heidelberg, Victoria, Australia; Department of Neurology (R.L.), University Hospitals Leuven; Department of Neurosciences (R.L.), KU Leuven, University of Leuven, Experimental Neurology; VIB (R.L.), Center for Brain & Disease Research, Laboratory of Neurobiology, Leuven, Belgium; School of Psychology & Neuroscience (K.M.), University of Glasgow, United Kingdom; Department of Stroke Medicine (N.N.), Université Claude Bernard Lyon 1, CREATIS CNRS UMR 5220-INSERM U1206, INSA; Hospices Civils de Lyon (N.N.), France; Department of Radiology (S.P.), Institut de Diagnostic per la Image (IDI), Hospital Dr Josep Trueta, Institut dInvestigació Biomèdica de Girona (IDIBGI), Girona, Spain; and Department of Neurology (C.Z.S.), Aarhus University Hospital, Denmark
| | - Götz Thomalla
- From the Klinik und Poliklinik für Neurologie (M.J., B.C., E.S., F.Q., E.B., G.T., C.G.), Kopf- und Neurozentrum, University Medical Center Hamburg-Eppendorf; Institut für Medizinische Biometrie und Epidemiologie (S.S., K.W.), Zentrum für Experimentelle Medizin, Universitätsklinikum Hamburg-Eppendorf, Germany; Hospices Civils de Lyon (F.B.), Service de Biostatistique; Université Lyon 1 (F.B.), Villeurbanne; and CNRS (F.B.), UMR 5558, Laboratoire de Biométrie et Biologie Evolutive, Villeurbanne, France; Centrum für Schlaganfallforschung Berlin (CSB) (M. Ebinger, M. Endres, J.F.) and Klinik und Hochschulambulanz für Neurologie (M. Endres), Charité-Universitätsmedizin Berlin; Neurologie (M. Ebinger), Medical Park Berlin Humboldtmühle; German Center for Neurodegenerative Disease (DZNE) (M. Endres), Partner Site Berlin; German Center for Cardiovascular Research (DZHK) (M. Endres), Partner Site Berlin; Excellence Cluster NeuroCure (M. Endres), Berlin, Germany; Florey Institute of Neuroscience and Mental Health (V.T.), University of Melbourne, Heidelberg, Victoria Department of Neurology (V.T.), Austin Health, Heidelberg, Victoria, Australia; Department of Neurology (R.L.), University Hospitals Leuven; Department of Neurosciences (R.L.), KU Leuven, University of Leuven, Experimental Neurology; VIB (R.L.), Center for Brain & Disease Research, Laboratory of Neurobiology, Leuven, Belgium; School of Psychology & Neuroscience (K.M.), University of Glasgow, United Kingdom; Department of Stroke Medicine (N.N.), Université Claude Bernard Lyon 1, CREATIS CNRS UMR 5220-INSERM U1206, INSA; Hospices Civils de Lyon (N.N.), France; Department of Radiology (S.P.), Institut de Diagnostic per la Image (IDI), Hospital Dr Josep Trueta, Institut dInvestigació Biomèdica de Girona (IDIBGI), Girona, Spain; and Department of Neurology (C.Z.S.), Aarhus University Hospital, Denmark
| | - Christian Gerloff
- From the Klinik und Poliklinik für Neurologie (M.J., B.C., E.S., F.Q., E.B., G.T., C.G.), Kopf- und Neurozentrum, University Medical Center Hamburg-Eppendorf; Institut für Medizinische Biometrie und Epidemiologie (S.S., K.W.), Zentrum für Experimentelle Medizin, Universitätsklinikum Hamburg-Eppendorf, Germany; Hospices Civils de Lyon (F.B.), Service de Biostatistique; Université Lyon 1 (F.B.), Villeurbanne; and CNRS (F.B.), UMR 5558, Laboratoire de Biométrie et Biologie Evolutive, Villeurbanne, France; Centrum für Schlaganfallforschung Berlin (CSB) (M. Ebinger, M. Endres, J.F.) and Klinik und Hochschulambulanz für Neurologie (M. Endres), Charité-Universitätsmedizin Berlin; Neurologie (M. Ebinger), Medical Park Berlin Humboldtmühle; German Center for Neurodegenerative Disease (DZNE) (M. Endres), Partner Site Berlin; German Center for Cardiovascular Research (DZHK) (M. Endres), Partner Site Berlin; Excellence Cluster NeuroCure (M. Endres), Berlin, Germany; Florey Institute of Neuroscience and Mental Health (V.T.), University of Melbourne, Heidelberg, Victoria Department of Neurology (V.T.), Austin Health, Heidelberg, Victoria, Australia; Department of Neurology (R.L.), University Hospitals Leuven; Department of Neurosciences (R.L.), KU Leuven, University of Leuven, Experimental Neurology; VIB (R.L.), Center for Brain & Disease Research, Laboratory of Neurobiology, Leuven, Belgium; School of Psychology & Neuroscience (K.M.), University of Glasgow, United Kingdom; Department of Stroke Medicine (N.N.), Université Claude Bernard Lyon 1, CREATIS CNRS UMR 5220-INSERM U1206, INSA; Hospices Civils de Lyon (N.N.), France; Department of Radiology (S.P.), Institut de Diagnostic per la Image (IDI), Hospital Dr Josep Trueta, Institut dInvestigació Biomèdica de Girona (IDIBGI), Girona, Spain; and Department of Neurology (C.Z.S.), Aarhus University Hospital, Denmark
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5
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Cheng B, Chen J, Königsberg A, Mayer C, Rimmele L, Patil KR, Gerloff C, Thomalla G, Eickhoff SB. Mapping the deficit dimension structure of the National Institutes of Health Stroke Scale. EBioMedicine 2022; 87:104425. [PMID: 36563488 PMCID: PMC9800288 DOI: 10.1016/j.ebiom.2022.104425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 12/04/2022] [Accepted: 12/07/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND The National Institutes of Health Stroke Scale (NIHSS) is the most frequently applied clinical rating scale for standardized assessment of neurological deficits in acute stroke in both clinical and research settings. Notwithstanding this prominent role, important questions regarding its validity remain insufficiently addressed: Investigations of the underlying dimensional structure of the NIHSS yielded inconsistent results that are largely not generalizable across studies. Neurobiological validations by linking measured deficit dimensions to brain anatomy and function are missing. METHODS We, therefore, employ advanced machine learning to identify an optimal representation of the dimensional structure of the NIHSS across two independent and heterogeneous stroke datasets (N = 503 and N = 690). Associated lesion locations are identified by multivariate lesion-deficit mapping (LDM) and their functional relevance is profiled based on a-priori task activation meta-data analysis, to provide an independent link to the behavioural level. FINDINGS A five-factor structure of the NIHSS was identified as the most robust and generalizable representation of stroke deficit dimensions across study populations, settings, and clinical phenotypes. Specifically, the identified dimensions comprised NIHSS items for (F1) left motor deficits, (F2) right motor deficits, (F3) dysarthria and facial palsy, (F4) language, and (F5) deficits in spatial attention and gaze. LDM linked four of these factors to differentially localized, eloquent neuroanatomical areas. Functional characterization of LDM results aligned with detected deficit dimensions, revealing associations with motor functions, language processing, and various functions in the perception domain. INTERPRETATION By cross-validating machine learning in heterogeneous multi-site stroke cohorts, we report evidence on the validity of the NIHSS: We identified an overarching structure of the NISHS containing a five-dimensional representation of stroke deficits. We provide an anatomical map of the NIHSS that is of value for future applications of individualized stroke treatment and rehabilitation. FUNDING This research was supported by the National Key R&D Program of China (Grant No. 2021YFC2502200), the National Human Brain Project of China (Grant No. 2022ZD0214000)", the German Research Foundation (Deutsche Forschungsgemeinschaft), Project 178316478 (A1, C1, C2), and Project 454012190 of the SPP 2041, the Helmholtz Portfolio Theme "Supercomputing and Modelling for the Human Brain" and Helmholtz Imaging Platform grant NimRLS (ZT-I-PF-4-010).
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Affiliation(s)
- Bastian Cheng
- Klinik und Poliklinik für Neurologie, Kopf- und Neurozentrum, University Medical Center Hamburg-Eppendorf, Hamburg, Germany,Corresponding author.
| | - Ji Chen
- Department of Psychology and Behavioral Sciences, Zhejiang University, Hangzhou, China,Institute of Neuroscience and Medicine, Brain & Behaviour (INM-7), Research Centre Jülich, Jülich, Germany,Corresponding author.
| | - Alina Königsberg
- Klinik und Poliklinik für Neurologie, Kopf- und Neurozentrum, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Carola Mayer
- Klinik und Poliklinik für Neurologie, Kopf- und Neurozentrum, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Leander Rimmele
- Klinik und Poliklinik für Neurologie, Kopf- und Neurozentrum, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Kaustubh R. Patil
- Institute of Neuroscience and Medicine, Brain & Behaviour (INM-7), Research Centre Jülich, Jülich, Germany,Institute of Systems Neuroscience, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Christian Gerloff
- Klinik und Poliklinik für Neurologie, Kopf- und Neurozentrum, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Götz Thomalla
- Klinik und Poliklinik für Neurologie, Kopf- und Neurozentrum, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Simon B. Eickhoff
- Institute of Neuroscience and Medicine, Brain & Behaviour (INM-7), Research Centre Jülich, Jülich, Germany,Institute of Systems Neuroscience, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
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6
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Heinze M, Lebherz L, Rimmele DL, Frese M, Jensen M, Barow E, Lettow I, Kriston L, Gerloff C, Härter M, Thomalla G. Higher comorbidity burden is associated with lower self-reported quality of life after stroke. Front Neurol 2022; 13:1023271. [DOI: 10.3389/fneur.2022.1023271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 10/26/2022] [Indexed: 11/11/2022] Open
Abstract
IntroductionThis study assesses the association of comorbidity burden and polypharmacy with self-reported quality of life after stroke.Patients and methodsWe performed a post-hoc analysis of a prospective, single-center, observational study of outcome evaluation by patient-reported outcome measures in stroke clinical practice. Consecutive patients with acute ischemic stroke (AIS) were enrolled and self-reported health–related quality of life (HrQoL) was assessed 90 days after acute stroke using the Patient-reported Outcomes Measurement Information System 10-Question Short-Form (PROMIS-10). Comorbidities at baseline were assessed by the Charlson Comorbidity Index (CCI). Polypharmacy was defined as medication intake of ≥5 at baseline. We used linear regression analysis to study the association of CCI, polypharmacy and other clinical covariates with HrQoL after stroke.ResultsOf 781 patients (median age 76 years, 48.4% female) enrolled, 30.2% had a CCI Score ≥2, and 31.5% presented with polypharmacy. At follow up, 71 (9.1%) had died. In 409 (52.4%) reached for outcome evaluation, Global Physical Health T-Score was 43.8 ± 10 and Global Mental Health T-Score was 43.5 ± 8.76, indicating lower HrQoL than the average population. A CCI Score ≥2, higher NIHSS Score, female sex, dependency on others for dressing, toileting and mobility before index stroke, atrial fibrillation and hypertension were independent predictors of worse physical and mental health outcomes, while polypharmacy was not.ConclusionIn patients with AIS, high comorbidity burden and polypharmacy are frequent. Comorbidity burden at admission is independently associated with worse self-reported physical and mental health three months after stroke.
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7
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Corrigan AE, Carter B, Smith A, Pennington A, Hewitt J. MORe PREcISE: a multicentre prospective study of patient reported outcome measures in stroke morbidity: a cross sectional study. BMC Neurol 2022; 22:145. [PMID: 35443653 PMCID: PMC9020003 DOI: 10.1186/s12883-022-02634-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Accepted: 02/24/2022] [Indexed: 11/10/2022] Open
Abstract
Background and Purpose The use of patient reported outcomes measures (PROMs) may offer utility that are important for stroke survivors. This study assessed the PROMIS-10, which contains Mental health (MH) and Physical Health (PH) domains, with an additional five stroke specific questions. The aim of this study was to evaluate the association between the MH and PH measures following a stroke and pre-existing health conditions. Methods A multicentre prospective cohort study at 19 hospital sites across England and Wales during 2019 was conducted. The association between each PROMIS-10 domain and demographic and health conditions were calculated using a multilevel multivariable linear and present the adjusted mean difference (aMD). Results The study enrolled 549 stroke survivors within 14 days of the index event, 232 were women (42.3%) and with a mean age of 72.7 years (SD = 12.9, range 25 to 97). The MH domain was scored as poor in 3.9% of participants, and very good or excellent in almost a half (48.4%). In contrast the PH domain was scored as poor in 39.9%, compared to very good or excellent in 8.5%. The MH domain was associated with pre-existing diabetes (aMD = − 2.01; 95%CI -3.91, − 0.12; p = 0.04), previous stroke (aMD = − 3.62; 95%CI -5.86, − 1.39; p = 0.001), age (aMD = 0.07; 95%CI: 0.01, 0.14; p = 0.037), and female sex (aMD = 1.91; 95%CI 0.28, 3.54; p = 0.022). The PH domain was found to be associated with sex (female) (aMD = 2.09; 95%CI 0.54, 3.65; p = 0.008) and previous stroke (aMD = − 3.05; 95%CI -5.17, − 0.93; p = 0.005). Conclusions Almost half of stroke survivors reported poor PH using a PROM with less reporting poor MH. age, and sex were associated with both MH and PH domains, and additionally pre-exising diabetes and stroke were associated with poorer MH. Clinical management offers an opportunity to investigate and intervene to prevent long term poorer health in stroke survivors. Supplementary Information The online version contains supplementary material available at 10.1186/s12883-022-02634-0.
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Affiliation(s)
- Amber E Corrigan
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Ben Carter
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Alexander Smith
- Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK
| | - Anna Pennington
- Aneurin Bevan University Health Board, Newport, South Wales, UK
| | - Jonathan Hewitt
- Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK. .,Aneurin Bevan University Health Board, Newport, South Wales, UK.
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8
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Lebherz L, Fraune E, Thomalla G, Frese M, Appelbohm H, Rimmele DL, Härter M, Kriston L. Implementability of collecting patient-reported outcome data in stroke unit care - a qualitative study. BMC Health Serv Res 2022; 22:346. [PMID: 35292028 PMCID: PMC8925160 DOI: 10.1186/s12913-022-07722-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 02/23/2022] [Indexed: 12/02/2022] Open
Abstract
Background Patient-reported outcome measures (PROMs) assess patient-relevant effects of medical treatments. We aimed to evaluate the implementation of the International Consortium for Health Outcomes Measurement Standard Set for Stroke (ICHOM-SSS) into routine inpatient care of a stroke unit. Methods The ICHOM-SSS was administered in a certified stroke unit during and after inpatient care. Semi-structured interviews with medical staff (n = 5) and patients or their proxies (n = 19) about their experience were audio-recorded and analysed using thematic analyses. Implementation outcomes were chosen in advance and adhered to current standards of implementation science. Results Patients perceived the ICHOM-SSS to be relevant and feasible. They reported limited understanding of why the assessment was introduced. The overall acceptance of using PROMs was high. While medical staff, too, perceived the assessment to be appropriate and relevant, their appraisal of feasibility, sustainability, and their acceptance of the implementation were low. Conclusions For a sustainable implementation of PROMs in clinical practice, IT resources need to be adapted, medical care needs to be reorganized, and additional clinical resources are required. Future research should investigate benefits of the ICHOM-SSS and a simpler, automated implementation in stroke care. Trial registration ClinicalTrials.gov Identifier: NCT03795948, retrospectively registered on 8 January 2019. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-07722-y.
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Affiliation(s)
- Lisa Lebherz
- Department of Medical Psychology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany.
| | - Elisa Fraune
- Department of Medical Psychology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Götz Thomalla
- Department of Neurology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Marc Frese
- Office for Quality Management and Clinical Process Management, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Hannes Appelbohm
- Department of Neurology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - David Leander Rimmele
- Department of Neurology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Martin Härter
- Department of Medical Psychology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Levente Kriston
- Department of Medical Psychology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
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9
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Rimmele DL, Thomalla G. [Long-term consequences of stroke]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2022; 65:498-502. [PMID: 35258642 DOI: 10.1007/s00103-022-03505-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 02/07/2022] [Indexed: 11/24/2022]
Abstract
The treatment of stroke has significantly improved over the past two decades, resulting in reduced mortality and morbidity in high-income countries. However, strokes remain the third leading cause of mortality and disability worldwide. In addition to acute care and the prevention of risk factors, treatment of the various persisting disabilities that impact the daily activities and quality of life of patients also remain important. Motor and language deficits affect everyday life most obviously. Other deficits may involve complex movements, sensory, and cognitive functions. Patients also often suffer from anxiety, fatigue, and depression.Established ergotherapeutic, physiotherapeutic, and logopedic programs exist for motor and language deficits for in-patient treatment as well as in the ambulatory setting. The diagnosis and treatment of cognitive impairments and behavioral disorders, however, are largely confined to the early rehabilitation phase. Despite indications of a long-term impairment of quality of life due to cognitive deficits and behavioral disorders, previous study results speak against drug-based antidepressant therapy in in-patient rehabilitation. Individual patient-reported outcomes, supported by screening for cognitive deficits and consideration of individual risk factors and coping strategies, could further improve the treatment of stroke and its long-term burden.
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Affiliation(s)
- David Leander Rimmele
- Klinik und Poliklinik für Neurologie, Universitätsklinik Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Deutschland
| | - Götz Thomalla
- Klinik und Poliklinik für Neurologie, Universitätsklinik Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Deutschland.
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Rimmele DL, Schrage T, Lebherz L, Kriston L, Gerloff C, Härter M, Thomalla G. Profiles of patients' self-reported health after acute stroke. Neurol Res Pract 2021; 3:43. [PMID: 34420516 PMCID: PMC8381585 DOI: 10.1186/s42466-021-00146-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 07/26/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND We aimed to identify groups of patients with similar health status after stroke, assessed by patient reported outcome measures (PROMs), to improve initial risk stratification. METHODS In a prospective study, inpatients were recruited during acute stroke treatment. Demographics, history, and cardio-vascular risk factors were assessed at baseline. Self-reported functional status, physical and mental health as well as anxiety and depressive symptoms were assessed 3 and 12 months after stroke and used to identify latent classes. The association of patient characteristics with latent class membership was investigated with multinomial logistic regression. RESULTS Of the 650 patients included with a mean age of 75 years and 48% female, 70% had ischemic, 6% hemorrhagic strokes, and 24% transient ischemic attacks. Median NIHSS on admission was 2 (IQR:0,5). Values of PROMs remained comparable at 3 and 12 months. A three-class model was developed, differentiating between patients with mildly (75%), moderately (17%), and severely (8%) impaired self-reported health status. Adjusted for univariately significant baseline characteristics, initial NIHSS distinguished mild- from moderate-, and moderate- from severe-class-membership (p < 0.001). Length of inpatient stay (p < 0.001;OR = 1.1), diabetes (p = 0.021;OR = 1.91), and atrial fibrillation (p = 0.004;OR = 2.20) predicted allocation to the moderately vs. mildly affected class. CONCLUSIONS Grading stroke patients by a standard set of PROMs up to 1 year after stroke allows to distinguish the diverse impact of baseline characteristics on differently affected groups. In addition to initial stroke severity, longer inpatient stay, presence of diabetes and atrial fibrillation correlate with greater impairment of self-reported health in the less affected groups. TRIAL REGISTRATION http://www.ClinicalTrials.gov ; Unique identifier: NCT03795948 .
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Affiliation(s)
- D Leander Rimmele
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany.
| | - Theresa Schrage
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Lisa Lebherz
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Levente Kriston
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Christian Gerloff
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Martin Härter
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Götz Thomalla
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
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11
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Philipp R, Lebherz L, Thomalla G, Härter M, Appelbohm H, Frese M, Kriston L. Psychometric properties of a patient-reported outcome set in acute stroke patients. Brain Behav 2021; 11:e2249. [PMID: 34124861 PMCID: PMC8413767 DOI: 10.1002/brb3.2249] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 05/25/2021] [Accepted: 05/27/2021] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVES Impairments after stroke may affect multiple domains of health-related quality of life (HRQoL). Patient-reported outcome measures (PROMs) have proven valuable in measuring patients' well-being. We examine the psychometric properties of a standard set of PROMs assessing global health, anxiety, and depression, and functioning in a German health care setting. METHOD We included inpatients at the Department of Neurology at the University Medical Center Hamburg-Eppendorf, diagnosed with stroke. Following the stroke-specific standard set of the International Consortium for Health Outcome Measurement, we collected demographic and clinical information at baseline, and PROMs for global health (PROMIS-10), three items for self-reported functioning, anxiety, and depression (PHQ-4) at 90 days follow-up. We calculated confirmatory factor analyses to test factorial validity and correlation analyses to test construct validity. We further conducted item and reliability analyses. RESULTS In a sample of 487 patients (mean age, SD: 71.1, 12.6; 47% female) with mild and moderate symptoms, model fit for the PROMIS-10 was acceptable for the two-factor and single-factor models. Factor loadings ranged from 0.52 to 0.94. The postulated single-factor model for functioning was saturated with zero degrees of freedom. Factor loadings ranged from 0.90 to 0.96. For the PHQ-4, the two-factor model showed excellent model fit. Factor loadings ranged from 0.78 to 0.87. Internal consistency was acceptable to good. Construct validity was generally confirmed. CONCLUSIONS The PROMIS-10 is a valid and reliable instrument to measure HRQoL among German stroke patients. While the PHQ-4 was confirmed as a screening measure for mental disorders, further research is needed on items assessing self-reported functioning. Results are limited to patients showing minimal functional deficits.
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Affiliation(s)
- Rebecca Philipp
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Lisa Lebherz
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Götz Thomalla
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Martin Härter
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Hannes Appelbohm
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Marc Frese
- Office for Quality Management and Clinical Process Management, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Levente Kriston
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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12
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Witsch J, Siegerink B, Nolte CH, Sprügel M, Steiner T, Endres M, Huttner HB. Prognostication after intracerebral hemorrhage: a review. Neurol Res Pract 2021; 3:22. [PMID: 33934715 PMCID: PMC8091769 DOI: 10.1186/s42466-021-00120-5] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 03/19/2021] [Indexed: 12/11/2022] Open
Abstract
Background Approximately half of patients with spontaneous intracerebral hemorrhage (ICH) die within 1 year. Prognostication in this context is of great importance, to guide goals of care discussions, clinical decision-making, and risk stratification. However, available prognostic scores are hardly used in clinical practice. The purpose of this review article is to identify existing outcome prediction scores for spontaneous intracerebral hemorrhage (ICH) discuss their shortcomings, and to suggest how to create and validate more useful scores. Main text Through a literature review this article identifies existing ICH outcome prediction models. Using the Essen-ICH-score as an example, we demonstrate a complete score validation including discrimination, calibration and net benefit calculations. Score performance is illustrated in the Erlangen UKER-ICH-cohort (NCT03183167). We identified 19 prediction scores, half of which used mortality as endpoint, the remainder used disability, typically the dichotomized modified Rankin score assessed at variable time points after the index ICH. Complete score validation by our criteria was only available for the max-ICH score. Our validation of the Essen-ICH-score regarding prediction of unfavorable outcome showed good discrimination (area under the curve 0.87), fair calibration (calibration intercept 1.0, slope 0.84), and an overall net benefit of using the score as a decision tool. We discuss methodological pitfalls of prediction scores, e.g. the withdrawal of care (WOC) bias, physiological predictor variables that are often neglected by authors of clinical scores, and incomplete score validation. Future scores need to integrate new predictor variables, patient-reported outcome measures, and reduce the WOC bias. Validation needs to be standardized and thorough. Lastly, we discuss the integration of current ICH scoring systems in clinical practice with the awareness of their shortcomings. Conclusion Presently available prognostic scores for ICH do not fulfill essential quality standards. Novel prognostic scores need to be developed to inform the design of research studies and improve clinical care in patients with ICH. Supplementary Information The online version contains supplementary material available at 10.1186/s42466-021-00120-5.
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Affiliation(s)
- Jens Witsch
- Department of Neurology, Weill Cornell Medicine, 525 East 68th Street, New York, NY, 10065, USA.
| | - Bob Siegerink
- Center for Stroke Research Berlin, Charité Universitätsmedizin, Berlin, Germany
| | - Christian H Nolte
- Center for Stroke Research Berlin, Charité Universitätsmedizin, Berlin, Germany.,Klinik und Hochschulambulanz für Neurologie, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Maximilian Sprügel
- Department of Neurology, Universitätsklinikum Erlangen, Erlangen, Germany
| | - Thorsten Steiner
- Department of Neurology, Klinikum Frankfurt Höchst, Frankfurt a. M., Germany.,Department of Neurology, Universität Heidelberg, Heidelberg, Germany
| | - Matthias Endres
- Center for Stroke Research Berlin, Charité Universitätsmedizin, Berlin, Germany.,Klinik und Hochschulambulanz für Neurologie, Charité Universitätsmedizin Berlin, Berlin, Germany.,German Center for Neurodegenerative Diseases (DZNE), Partner Site Berlin, Berlin, Germany.,German Centre for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany
| | - Hagen B Huttner
- Department of Neurology, Universitätsklinikum Erlangen, Erlangen, Germany
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13
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Rimmele DL, Schrage T, Brettschneider C, Engels A, Gerloff C, Härter M, Rosenkranz M, Schmidt H, Kriston L, Thomalla G. Rationale and design of an interventional study of cross-sectoral, coordinated treatment of stroke patients with patient-orientated outcome measurement (StroCare). Neurol Res Pract 2021; 3:7. [PMID: 33526148 PMCID: PMC7850714 DOI: 10.1186/s42466-021-00107-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2021] [Accepted: 01/13/2021] [Indexed: 01/23/2023] Open
Abstract
INTRODUCTION Stroke has a long-term impact on functional status and quality of life in multiple health domains. A well-coordinated managed care program for stroke patients is crucial for ameliorating patients' health and cost-efficient use of resources. The aim of this study is the implementation and evaluation of an optimised cross-sectoral, coordinated and managed care program for stroke patients bridging secondary and tertiary care. METHODS In this multi-center mixed method sequentially controlled intervention study, stroke patients with ischemic stroke (I63), transient ischemic attack and related syndromes (G45), or intracerebral haermorrhage (I64) will be invited to participate. For a 12-months period, 235 consecutive patients are expected to be enrolled and assigned standard of care treatment as an active control group. During the following 12 months, 235 consecutive patients will be enrolled and assigned to a post stroke intervention program. The StroCare intervention consists of repeated outpatient visits with specialized stroke teams, the implementation of a case manager, the use of an electronical tool for communication between acute care, rehabilitation facilities, and out-patient care, and the definition of individualized treatment targets. Patients will be followed up for 24 months. The primary outcome is health-related quality of life measured by the Patient-Reported Outcomes Measurement Information System 10-Question Short Form (PROMIS-10) at 12 months after the index event, i.e. stroke or TIA. For the qualitative survey of the implementation process, 21 patients in the intervention group will be interviewed after implementation of the interventions. In addition, 20 health care providers and staff members will be interviewed before and after implementation. Additionally, economic outcomes will be evaluated after 6 and 12 months. PERSPECTIVE The study will not only provide information about the tested intervention but is likely to be helpful for clinicians, suppliers of reimbursement, and researchers in implementing and evaluating complex interventions in stroke care in general. With this program, the health care system will have a reference model at its disposal for transfer to other regions and settings. TRIAL REGISTRATION The trial is registered at ClinicalTrials.gov ( NCT04159324 ). Approval of the local ethics committee (Ethik-Kommission der Ärztekammer Hamburg, Niedersachsen, Schleswig-Holstein) has been obtained.
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Affiliation(s)
- David Leander Rimmele
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany.
| | - Theresa Schrage
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Christian Brettschneider
- Department of Health Economics and Health Care Research, University Medical Center Hamburg Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Alexander Engels
- Department of Health Economics and Health Care Research, University Medical Center Hamburg Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Christian Gerloff
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Martin Härter
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Michael Rosenkranz
- Department of Neurology and Neurological Early Rehabilitation, Albertinen Krankenhaus, Süntelstraße 11A, 22457, Hamburg, Germany
| | - Holger Schmidt
- Department of Neurology, Elbe Klinik Stade, Bremervörderstraße 111, 21682, Stade, Germany
- Department of Neurology, University Medical Center Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Germany
| | - Levente Kriston
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Götz Thomalla
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
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14
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Rimmele DL, Lebherz L, Frese M, Appelbohm H, Bartz HJ, Kriston L, Gerloff C, Härter M, Thomalla G. Health-related quality of life 90 days after stroke assessed by the International Consortium for Health Outcome Measurement standard set. Eur J Neurol 2020; 27:2508-2516. [PMID: 32810906 DOI: 10.1111/ene.14479] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 08/11/2020] [Indexed: 12/01/2022]
Abstract
BACKGROUND AND PURPOSE Stroke has detrimental effects in multiple health domains not captured by routine scales. The International Consortium for Health Outcome Measurement has developed a standardized set for self-reported assessment to overcome this limitation. The aim was to assess this set in acute stroke care. METHODS Consecutive patients with acute ischaemic stroke, transient ischaemic attack or intracerebral hemorrhage were enrolled. Demographics, living situation and cardiovascular risk factors were collected from medical records and interviews. The Patient-reported Outcomes Measurement Information System 10-Question Short Form (PROMIS-10) and the Patient Health Questionnaire-4 (PHQ-4) were conducted 90 days after admission. Linear and logistic regression analyses were used to identify predictors of outcome. The study is registered at ClinicalTrials.gov, NCT03795948. RESULTS In all, 1064 patients were enrolled; mean age was 71.6 years, 51% were female, and median National Institutes of Health Stroke Scale (NIHSS) on admission was 3. Diagnosis was acute ischaemic stroke in 74%, transient ischaemic attack in 20% and intracerebral hemorrhage in 6%. 673 patients were available for outcome evaluation at 90 days; of these 90 (13%) had died. In survivors, t scores of PROMIS-10 physical and mental health were 40.3 ± 6.17 and 44.3 ± 8.63, compared to 50 ± 10 in healthy populations. 16% reported symptoms indicating depression or anxiety on the PHQ-4. Higher NIHSS, prior stroke and requiring help pre-stroke predicted lower values in physical and mental health scores. Higher NIHSS and diabetes were associated with anxiety or depression. CONCLUSIONS Integrated in the routine of acute stroke care, systematic assessment of patient-reported outcomes reveals impairments in physical and mental health. Main predictors are severity of stroke symptoms and comorbidities such as hypertension and diabetes.
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Affiliation(s)
- D L Rimmele
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - L Lebherz
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - M Frese
- Quality Management and Clinical Process Management, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - H Appelbohm
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - H-J Bartz
- Quality Management and Clinical Process Management, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - L Kriston
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - C Gerloff
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - M Härter
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - G Thomalla
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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