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Nobels-Janssen E, Postma EN, Abma IL, van Dijk JMC, de Ridder IR, Schenck H, Moojen WA, den Hertog MH, Nanda D, Potgieser ARE, Coert BA, Verhagen WIM, Bartels RHMA, van der Wees PJ, Verbaan D, Boogaarts HD. Validity of the modified Rankin Scale in patients with aneurysmal subarachnoid hemorrhage: a randomized study. BMC Neurol 2024; 24:23. [PMID: 38216872 PMCID: PMC10785372 DOI: 10.1186/s12883-023-03479-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 11/27/2023] [Indexed: 01/14/2024] Open
Abstract
PURPOSE The modified Rankin Scale (mRS), a clinician-reported outcome measure of global disability, has never been validated in patients with aneurysmal subarachnoid hemorrhage (aSAH). The aims of this study are to assess: (1) convergent validity of the mRS; (2) responsiveness of the mRS; and (3) the distribution of mRS scores across patient-reported outcome measures (PROMs). METHODS This is a prospective randomized multicenter study. The mRS was scored by a physician for all patients, and subsequently by structured interview for half of the patients and by self-assessment for the other half. All patients completed EuroQoL 5D-5L, RAND-36, Stroke Specific Quality of Life scale (SS-QoL) and Global Perceived Effect (GPE) questionnaires. Convergent validity and responsiveness were assessed by testing hypotheses. RESULTS In total, 149 patients with aSAH were included for analysis. The correlation of the mRS with EQ-5D-5L was r = - 0.546, while with RAND-36 physical and mental component scores the correlation was r = - 0.439and r = - 0.574 respectively, and with SS-QoL it was r = - 0.671. Three out of four hypotheses for convergent validity were met. The mRS assessed through structured interviews was more highly correlated with the mental component score than with the physical component score of RAND-36. Improvement in terms of GPE was indicated by 83% of patients; the mean change score of these patients on the mRS was - 0.08 (SD 0.915). None of the hypotheses for responsiveness were met. CONCLUSION The results show that the mRS generally correlates with other instruments, as expected, but it lacks responsiveness. A structured interview of the mRS is best for detecting disabling neuropsychological complaints. REGISTRATION URL: https://trialsearch.who.int ; Unique identifier: NL7859, Date of first administration: 08-07-2019.
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Affiliation(s)
- E Nobels-Janssen
- Department of Neurology, Haga Teaching Hospital, The Hague, The Netherlands.
- Department of Neurosurgery, Radboud University Medical Center, PO Box 9101, Nijmegen, 6500 HB, The Netherlands.
| | - E N Postma
- Amsterdam UMC, Department of Neurosurgery, Amsterdam Neuroscience, University of Amsterdam, Amsterdam, The Netherlands
| | - I L Abma
- IQ healthcare and Department of Rehabilitation, Radboud University Medical Center, Radboud Institute of Health Sciences, Nijmegen, The Netherlands
| | - J M C van Dijk
- Department of Neurosurgery, University Medical Center Groningen, Groningen, The Netherlands
| | - I R de Ridder
- Department of Neurology, Maastricht University Medical Center, Cardiovascular Research Institute, Maastricht, The Netherlands
| | - H Schenck
- Department of Neurology, Maastricht University Medical Center, Cardiovascular Research Institute, Maastricht, The Netherlands
| | - W A Moojen
- Department of Neurosurgery, Haaglanden Medical Center, The Hague, The Netherlands
- Department of Neurosurgery, Leiden University Medical Center, Leiden, The Netherlands
- Department of Neurosurgery, Haga Teaching Hospital, The Hague, The Netherlands
| | - M H den Hertog
- Department of Neurology, Isala Hospital, Zwolle, The Netherlands
| | - D Nanda
- Department of Neurosurgery, Isala Hospital, Zwolle, The Netherlands
| | - A R E Potgieser
- Department of Neurosurgery, Medisch Spectrum Twente, Enschede, The Netherlands
| | - B A Coert
- Amsterdam UMC, Department of Neurosurgery, Amsterdam Neuroscience, University of Amsterdam, Amsterdam, The Netherlands
| | - W I M Verhagen
- Department of Neurology, Haga Teaching Hospital, The Hague, The Netherlands
| | - R H M A Bartels
- Department of Neurosurgery, Radboud University Medical Center, PO Box 9101, Nijmegen, 6500 HB, The Netherlands
| | - P J van der Wees
- IQ healthcare and Department of Rehabilitation, Radboud University Medical Center, Radboud Institute of Health Sciences, Nijmegen, The Netherlands
| | - D Verbaan
- Amsterdam UMC, Department of Neurosurgery, Amsterdam Neuroscience, University of Amsterdam, Amsterdam, The Netherlands
| | - H D Boogaarts
- Department of Neurosurgery, Radboud University Medical Center, PO Box 9101, Nijmegen, 6500 HB, The Netherlands
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Nobels-Janssen E, Abma IL, de Ridder IR, Haeren RHL, Hertog MH, Nanda D, van der Pol B, Verhagen WIM, Bartels RHMA, van der Wees PJ, Boogaarts HD. The SOS-SAH questionnaire in clinical practice: a multi-method evaluation study. BMC Neurol 2023; 23:236. [PMID: 37337139 DOI: 10.1186/s12883-023-03280-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 06/06/2023] [Indexed: 06/21/2023] Open
Abstract
BACKGROUND In patients with mild disabilities after aneurysmal subarachnoid hemorrhage (aSAH), invisible symptoms might be easily overlooked during consultations in the outpatient clinic. We hypothesize that the Questionnaire for the Screening of Symptoms in aneurysmal Subarachnoid Hemorrhage (SOS-SAH), a disease-specific patient-reported outcome measure, might aid in screening for symptoms after aSAH. The objective of this explorative study is to evaluate the perceived impact of using the SOS-SAH in daily clinical practice for patients after aSAH, as well as to explore potential barriers to further implementation. METHODS This multi-method study consists of a quantitative and a qualitative component. To evaluate differences in quality of care, a patient experience survey was sent to patients receiving usual care and to patients who received the SOS-SAH. A multiple linear regression model was applied, with the intervention group and case mix adjusters as independent variables. We described differences in the number of symptoms discussed between patients receiving usual care and those receiving care post-implementation. Following implementation, 16 patients and 6 healthcare professionals were interviewed about their perceptions concerning the impact of and barriers to using the SOS-SAH. A thematic analysis was performed to identify the main themes. RESULTS The survey did not reveal any differences between the usual-care group and the post-implementation group on the scales of the patient experience survey. After implementation of the SOS-SAH, the number of symptoms discussed during consultation did not increase. The interviews suggest that the SOS-SAH may improve the preparation of patients by providing them with greater insight into their complaints and by raising issues for the consultation. It could also enhance the structure and efficiency of consultation, in addition to improving communication about issues that matter to patients. All patients and healthcare professionals recommended continuing the use of the SOS-SAH in daily practice. CONCLUSIONS Although no quantitative improvements were found in patient experience and symptoms discussed during consultation, implementation of the SOS-SAH could aid in screening for symptoms in patients after aSAH, and it might have a positive influence on patient preparation, while helping to structure consultations between patients and healthcare professionals.
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Affiliation(s)
- E Nobels-Janssen
- Department of Neurology, Canisius Wilhelmina Hospital, Nijmegen, the Netherlands.
- Department of Neurosurgery, Radboud University Medical Center, Nijmegen, the Netherlands.
| | - I L Abma
- IQ healthcare, Radboud University Medical Center, Radboud Institute of Health Sciences, Nijmegen, the Netherlands
| | - I R de Ridder
- Department of Neurology, Maastricht University Medical Center, Cardiovascular Research Institute Maastricht, Maastricht, the Netherlands
| | - R H L Haeren
- Department of Neurosurgery, Maastricht University Medical Center, Maastricht, the Netherlands
| | - M H Hertog
- Department of Neurology, Isala Hospital, Zwolle, the Netherlands
| | - D Nanda
- Department of Neurosurgery, Isala Hospital, Zwolle, the Netherlands
| | - B van der Pol
- Department of Neurosurgery, Elisabeth-TweeSteden Hospital, Tilburg, the Netherlands
| | - W I M Verhagen
- Department of Neurology, Canisius Wilhelmina Hospital, Nijmegen, the Netherlands
| | - R H M A Bartels
- Department of Neurosurgery, Radboud University Medical Center, Nijmegen, the Netherlands
| | - P J van der Wees
- IQ healthcare, Radboud University Medical Center, Radboud Institute of Health Sciences, Nijmegen, the Netherlands
| | - H D Boogaarts
- Department of Neurosurgery, Radboud University Medical Center, Nijmegen, the Netherlands
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Smaal JA, de Ridder IR, Heshmatollah A, van Zwam WH, Dippel D, Majoie CB, Brown S, Goyal M, Campbell B, Muir KW, Demchuck AM, Davalos A, Jovin TG, Mitchell PJ, White P, Saver JL, Hill MD, Roos YB, van der Lugt A, van Oostenbrugge RJ. Effect of atrial fibrillation on endovascular thrombectomy for acute ischemic stroke. A meta-analysis of individual patient data from six randomised trials: Results from the HERMES collaboration. Eur Stroke J 2020; 5:245-251. [PMID: 33072878 PMCID: PMC7538768 DOI: 10.1177/2396987320923447] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Accepted: 04/03/2020] [Indexed: 12/22/2022] Open
Abstract
Background Atrial fibrillation is an important risk factor for ischemic stroke, and is
associated with an increased risk of poor outcome after ischemic stroke.
Endovascular thrombectomy is safe and effective in acute ischemic stroke
patients with large vessel occlusion of the anterior circulation. This
meta-analysis aims to investigate whether there is an interaction between
atrial fibrillation and treatment effect of endovascular thrombectomy, and
secondarily whether atrial fibrillation is associated with worse outcome in
patients with ischemic stroke due to large vessel occlusion. Methods Individual patient data were from six of the recent randomised clinical
trials (MR CLEAN, EXTEND-IA, REVASCAT, SWIFT PRIME, ESCAPE, PISTE) in which
endovascular thrombectomy plus standard care was compared to standard care
alone. Primary outcome measure was the shift on the modified Rankin scale
(mRS) at 90 days. Secondary outcomes were functional independence (mRS 0–2)
at 90 days, National Institutes of Health Stroke Scale score at 24 h,
symptomatic intracranial hemorrhage and mortality at 90 days. The primary
effect parameter was the adjusted common odds ratio, estimated with ordinal
logistic regression (shift analysis); treatment effect modification of
atrial fibrillation was assessed with a multiplicative interaction term. Results Among 1351 patients, 447 patients had atrial fibrillation, 224 of whom were
treated with endovascular thrombectomy. We found no interaction of atrial
fibrillation with treatment effect of endovascular thrombectomy for both
primary (p-value for interaction: 0.58) and secondary
outcomes. Regardless of treatment allocation, we found no difference in
primary outcome (mRS at 90 days: aOR 1.11 (95% CI 0.89–1.38) and secondary
outcomes between patients with and without atrial fibrillation. Conclusion We found no interaction of atrial fibrillation on treatment effect of
endovascular thrombectomy, and no difference in outcome between large vessel
occlusion stroke patients with and without atrial fibrillation.
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Affiliation(s)
- J A Smaal
- Maastricht University Medical Center, Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands
| | - I R de Ridder
- Maastricht University Medical Center, Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands
| | - A Heshmatollah
- Department of Neurology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - W H van Zwam
- Maastricht University Medical Center, Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands
| | - Dwj Dippel
- Department of Neurology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - C B Majoie
- Department of Radiology & Nuclear Medicine, Amsterdam University Medical Centers, location AMC, Amsterdam, the Netherlands
| | - S Brown
- Altair Biostatistics, St Louis Park, MN, USA
| | - M Goyal
- Department of Radiology, University of Calgary, Foothills Hospital, Calgary, AB, Canada
| | - Bcv Campbell
- Department of Medicine and Neurology, Melbourne Brain Centre, Royal Melbourne Hospital, University of Melbourne, Parkville, VIC, Australia
| | - K W Muir
- Institute of Neuroscience and Psychology, University of Glasgow, Queen Elizabeth University Hospital, Glasgow, UK
| | - A M Demchuck
- Department of Clinical Neurosciences, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Foothills Hospital, Calgary, AB, Canada
| | - A Davalos
- Department of Neuroscience, University Autònoma de Barcelona, Spain
| | - T G Jovin
- Stroke Institute, Department of Neurology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - P J Mitchell
- Department of Radiology, Royal Melbourne Hospital, University of Melbourne, Melbourne, VIC, Australia
| | - P White
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK
| | - J L Saver
- Department of Neurology, Amsterdam University Medical Centers, location AMC, Amsterdam, the Netherlands
| | - M D Hill
- Department of Clinical Neurosciences, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Foothills Hospital, Calgary, AB, Canada
| | - Y B Roos
- Department of Neurology, Amsterdam University Medical Centers, location AMC, Amsterdam, the Netherlands
| | - A van der Lugt
- Department of Radiology and Nuclear Medicine, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - R J van Oostenbrugge
- Maastricht University Medical Center, Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands
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