Association of stroke severity with functional outcome using National Institute of Health (NIH), Functional Independence Measurement(FIM) and Stroke Specific Quality of Life (SSQOL) in stroke patients

Introduction: Stroke is the leading cause of long-term disability and affects 795,000 people in the U.S. each year. This study was conducted to enhance knowledge of outcomes during recovery and the options for participating in rehabilitation and preventive care during patients’ transitions to the community. Comprehensive Stroke Certification charges hospitals with the task of expanding knowledge of functional and quality of life outcomes for all stroke patients through the continuum examining effects of stroke severity, functional impairment, and patient characteristics on discharge destinations, functional independence, and quality of life after discharge. Methods: Retrospective analysis of an acute stroke quality improvement database which includes measures collected by MedTel Outcomes LLC on all stroke patients one month after discharge. Included, is the Functional Independence Measure and standardized quality of life and participation measures. In the database are standardized measures from the medical record such stroke type, Modified Rankin score, and acute functional independence measure score for 719 patients with a 30-day follow-up phone assessment for functional and quality of life measures from January 1, 2011 to December 31, 2012. Preliminary Findings: Over 75% of patients had hemiparesis, & over 90% survived 30-days post discharge and were living in the community. At follow-up, mostwere independent in self-care, and half were independent in mobility excluding stairs. Those with right brain involvement had a complicated, slower recovery. Those with left brain involvement,had lower functional scores and a higher percentage of them were not living in the community, rather, living in institutions. Conclusions: All patients experiencing a stroke should have evidence-based information on their options & what to expect during their recovery during their transitions into the community. The data base is useful as a source of outcome data for comparative effectiveness and to build a regional collaborative outcomes database for Comparative Effectiveness Research and quality benchmarking. Findings can be used to understand the functional trajectory of recovery based on severity of stroke and other factors.

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Abstract TP160: Degree of Functional Independence After an Ischemic Stroke Affects Quality of Life Similarly in Men and Women

Stroke ◽

10.1161/str.47.suppl_1.tp160 ◽

2016 ◽

Vol 47 (suppl_1) ◽

Author(s):

Stacie L Demel ◽

Jane Khoury ◽

Charles J Moomaw ◽

Heidi Sucharew ◽

Kathleen Alwell ◽

...

Keyword(s):

Quality Of Life ◽

Ischemic Stroke ◽

Functional Outcome ◽

Retrospective Chart Review ◽

Functional Independence ◽

Stroke Severity ◽

Men And Women ◽

Related Data ◽

Proxy Responses

Background: Women have worse quality of life (QoL) after an ischemic stroke (IS) compared with men for unclear reasons. We hypothesized that men and women may value functional independence differently. We assessed the association between sex, functional outcome, and quality of life within a large prospective cohort of ischemic stroke patients. Methods: Within the Greater Cincinnati/Northern Kentucky catchment area of 1.3 million we prospectively screened local hospital stroke admission diagnoses in 2005 and 2010. A subset of physician-confirmed IS patients were interviewed at baseline and followed longitudinally. Medical history and stroke-related data were collected through standardized retrospective chart review. Pre-stroke and 3-month modified Rankin Scale (mRS) was assessed, and European Quality of Life (EQ-5D) was administered at 3 months. Multiple regression analysis was used to compare QoL between men and women across mRS categories, adjusted for age, race, baseline mRS, stroke severity history of depression, diabetes, and use of proxy responses. Results: The GCNK follow-up cohorts from 2005 and 2010 included 964 adult IS patients, of which 797 were interviewed at 3 months post stroke. Women comprised 50% of the cohort and were older than men on average (68.4 ± 14.2 vs. 65.2 ± 13, p<.001) years at the time of their stroke. Women had worse functional outcomes (median mRS 3 vs. 2, p=.02) and quality of life (EQ-5D 0.55 vs. 0.65, p=.03), even after adjustment for the covariates listed above. The EQ-5D index was no different in men and women for each point on the mRS spectrum (i.e., there was no interaction between sex and 3-month mRS; Figure). Conclusion: In this cohort study, we confirmed worse functional outcome and worse quality of life in women after stroke. However, at each level on the mRS spectrum, men and women valued their quality of life similarly. Further research is needed on the reasons for worse outcomes in women than men.

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Long-term Neurological Outcome and Quality of Life after World Federation of Neurosurgical Societies Grades IV and V Aneurysmal Subarachnoid Hemorrhage in an Interdisciplinary Treatment Concept

Neurosurgery ◽

10.1093/neuros/nyw138 ◽

2017 ◽

Vol 80 (6) ◽

pp. 967-974 ◽

Cited By ~ 15

Author(s):

Christoph Schwartz ◽

Thomas Pfefferkorn ◽

Caroline Ebrahimi ◽

Caroline Ottomeyer ◽

Gunther Fesl ◽

...

Keyword(s):

Quality Of Life ◽

Functional Outcome ◽

Short Form ◽

Functional Independence ◽

World Federation ◽

Long Term Survivors ◽

Short Form Health

Abstract BACKGROUND: Detailed data on long-term functional outcome of patients with World Federation of Neurosurgical Societies (WFNS) grades IV and V aneurysmal subarachnoid hemorrhages (aSAH) are still scarce. OBJECTIVE: Assessment of long-term outcome of WFNS IV and V aSAH patients. METHODS: Functional outcome and quality of life were assessed by the modified Rankin scale (mRS) and the 36-item short-form health survey in consecutively treated aSAH WFNS IV and V patients between 2005 and 2010. Scores from the 36-item short-form health survey were compared to a healthy German population. Prognostic factors were analyzed by uni- and multivariate models. RESULTS: One hundred and seven eligible patients (median age: 53.0 years) were identified. After interdisciplinary consensus on optimal treatment, aneurysms were obliterated either by clipping (n = 35) or by coiling (n = 72). Ten patients were lost to long-term follow-up; the median clinical follow-up period was 3.2 years for the remaining 97 cases. Twenty-five of 97 died during the acute hospital phase and another 10 patients over the follow-up period leaving 62 long-term survivors. At the end of clinical follow-up, 40/97 patients, including 40/62 of long-term survivors, reached functional independence (mRS ≤ 2). Twelve of 97 patients were moderately (mRS = 3), 10/97 patients were severely disabled (mRS ≥ 4). Younger age (≤ 53 years; P = .001) and radiological absence of cerebral infarction (P = .03) were the strongest predictors for favorable outcome. Quality of life was perceived to be only moderately reduced compared to the healthy control group. CONCLUSION: Poor-grade aSAH is not necessarily associated with poor long-term functional outcome; after aneurysm repair ∼60% of patients survived and among long-term survivors ∼ 60% regained functional independence.

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Influence of Physical Therapy and Cholinergic Medication on the Life Quality Parameters in Post-Stroke with the arm Motor Dysfunction

Archive of Clinical Medicine ◽

10.21802/acm.2021.1.2 ◽

2021 ◽

Vol 27 (1) ◽

Author(s):

Iriah Festus Uwa-Agbonikhena

Keyword(s):

Quality Of Life ◽

Physical Therapy ◽

Functional Independence ◽

Motor Dysfunction ◽

Stroke Patients ◽

Post Stroke ◽

Group 3 ◽

Group 2 ◽

Group 1

Motor dysfunction makes the greatest contribution to the patient’s functional independence and has a significant impact on the quality of life (QOL) of post-stroke patients. The objective of the research was to evaluate the impact of different physical therapy approaches and choline alphoscerate on the functional independence and quality of life in patients in 1 year after ischemic stroke. Materials and methods. There were 104 patients examined in 1-year period after first anterior circulation ischemic stroke. Neurological status, functional independence and QOL were assessed according to the National Institute of Health Stroke Scale (NIHSS), modified Rankin Scale (mRS), Functional Independence Measurement (FIM) and Stroke Specific Quality of Life Scale (SS-QOL). Patients in Group 1 received secondary stroke prevention therapy and performed the exercises complex for general muscle function improvement for 2 months; patients in Group 2 also performed the exercise complex for hand motility improvement for 2 months; patients in Group 3 received choline alphoscerate 400 mg twice a day for 2 months in addition to the abovementioned physical therapy. Results. 2 months of physical therapy in Group 1 resulted in increase of “Transfer” and subtotal motor scores. A significant increase in the “Self-care”, “Transfer” and therefore subtotal motor and total scores was observed in the patients in Group 2 and Group 3; the motor subtotal and total scores in Group 3 were 11.4% and 11.6 % higher than the same indices in Group 1, respectively. The most significant improvement of QOL parameters was observed in patients in Group 3, whose total score increased by 36.8% from the baseline (p<0.05), and exceeded the same index of Group 1 by 17.1% (p<0.05). Conclusions. Adding of hand exercise into the physical therapy complex for post-stroke patients contributes to better upper extremity motor performance and therefore functional independence. Stimulation of cholinergic neurotransmission with the choline alphoscerate may also increase the efficacy of physical therapy and contribute to patients’ general mobility, upper extremity function and QOL.

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The Benefit of Endovascular Thrombectomy for Stroke on Functional Outcome Is Sustained at 12 Months

Cerebrovascular Diseases Extra ◽

10.1159/000517929 ◽

2021 ◽

pp. 81-86

Author(s):

Balaki Parameshwaran ◽

Dennis Cordato ◽

Mark Parsons ◽

Andrew Cheung ◽

Nathan Manning ◽

...

Keyword(s):

Quality Of Life ◽

Functional Outcome ◽

Health Utility Index ◽

Health Utility ◽

Functional Independence ◽

Place Of Residence ◽

Endovascular Thrombectomy ◽

Comprehensive Stroke Center ◽

Stroke Center

Background and Purpose: The short-term benefits of endovascular thrombectomy (EVT) for acute ischemic stroke (AIS) have been widely documented, yet there is limited evidence to show that this is sustained in the long term. We aimed to determine whether the benefit of EVT on functional outcome at 3 months is maintained at 12 months and the factors correlating with functional independence and quality of life. Methods: Data for analysis came from a prospective registry of consecutive patients undergoing EVT at a single Comprehensive Stroke Center (Oct 2018–Sep 2019). A phone interview was conducted for 12-month patient outcomes. Functional outcome was assessed by the modified Rankin Scale (mRS). Quality of life was determined by return to usual place of residence, work, or driving and calculation of a health utility index using the European Quality of Life-5 Dimensions questionnaire (EQ-5D-3L). Results: Of the 151 patients who underwent EVT during the study period, 12-month follow-up was available for 145 (96%). At 12 months, 44% (n = 64) of patients were functionally independent (mRS 0–2) compared to 48% at 3 months. Mortality at 12 months was 26% compared to 17% at 3 months. Significant predictors of functional independence at 12 months were younger age and lower baseline National Institutes of Health Stroke Scale. Better quality of life significantly correlated with return to usual place of residence and driving. Conclusion: Three-month functional independence was sustained at 12 months, indicating that EVT remains beneficial for patients with AIS in the longer term.

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Abstract 210: Is Endovascular Treatment Beneficial in Acute Ischemic Stroke Patients With M2 Segment Middle Cerebral Artery Occlusion?

Stroke ◽

10.1161/str.48.suppl_1.210 ◽

2017 ◽

Vol 48 (suppl_1) ◽

Author(s):

Adnan I Qureshi ◽

Muhammad A Saleem

Keyword(s):

Quality Of Life ◽

Ischemic Stroke ◽

Endovascular Treatment ◽

Middle Cerebral Artery ◽

Acute Ischemic Stroke ◽

Cerebral Artery ◽

Functional Independence ◽

Neurological Deterioration ◽

Stroke Patients

Background: The benefit of endovascular treatment in acute ischemic stroke patients with occlusion of distal middle cerebral artery (M2 segment) is unclear. Methods: We analyzed data from subjects with occlusion of M2 segment of middle cerebral artery confirmed with computed tomographic (CT) angiogram who were randomized to either intravenous (IV) recombinant tissue plasminogen activator (rt-PA) alone or in combination with endovascular treatment. We compared the rates of neurological deterioration within 24 hours; symptomatic intracranial hemorrhage (ICH) within 30 hours; good quality of life (defined by EQ-5D index score of ≥0.6) and functional independence (defined by modified Rankin scale of 0-2) at 3 months among subjects who underwent endovascular treatment with subjects who received IV rt-PA alone. Results: Of these 51 subjects (mean age ±SD; 68.3±11.8 years) with M2 segment occlusion, 34 and 17 subjects received IV rt-PA followed by endovascular treatment and IV rt-PA alone, respectively. There was a non-significantly lower rate of neurological deterioration (14.7% versus 25.0%) and symptomatic intracranial hemorrhages (5.9% versus 17.6%) among subjects who received IV rt-PA followed by endovascular treatment. At 3 months, the rates of independent functional outcome (52.9% versus 41.2%, odds ratio [OR] 1.6; 95 % confidence interval [CI] 0.5-5.2; P = 0.46) and good quality of life (50.0% vs 35.3% OR 1.9; 95% CI 0.5-7.2; p=0.37) were non-significantly higher among subjects with M2 segment occlusion who received IV rt-PA followed by endovascular treatment. The rate of death within 3 months was significantly lower among those who received IV rt-PA followed by endovascular treatment (5.9% vs 35.3%; OR 0.2; 95% CI 0.1-0.9; p=0.048). Conclusions: A randomized clinical trial should be considered based on the significant reduction in mortality and non-significant increase in functional independence and good quality of life following endovascular treatment in among acute ischemic stroke patients with M2 segment occlusion.

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Fatigue Impact Scale Demonstrates Greater Fatigue in Younger Stroke Survivors

Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques ◽

10.1017/s0317167100015353 ◽

2012 ◽

Vol 39 (5) ◽

pp. 619-625 ◽

Cited By ~ 23

Author(s):

Natalie E. Parks ◽

Gail A. Eskes ◽

Gordon J. Gubitz ◽

Yvette Reidy ◽

Christine Christian ◽

...

Keyword(s):

Quality Of Life ◽

Ischemic Stroke ◽

Stroke Severity ◽

Stroke Patients ◽

Younger Patients ◽

Post Stroke ◽

Impact Scale ◽

Fatigue Impact Scale ◽

One Year

Background:Fatigue affects 33-77% of stroke survivors. There is no consensus concerning risk factors for fatigue post-stroke, perhaps reflecting the multifaceted nature of fatigue. We characterized post-stroke fatigue using the Fatigue Impact Scale (FIS), a validated questionnaire capturing physical, cognitive, and psychosocial aspects of fatigue.Methods:The Stroke Outcomes Study (SOS) prospectively enrolled ischemic stroke patients from 2001-2002. Measures collected included basic demographics, pre-morbid function (Oxford Handicap Scale, OHS), stroke severity (Stroke Severity Scale, SSS), stroke subtype (Oxfordshire Community Stroke Project Classification, OCSP), and discharge function (OHS; Barthel Index, BI). An interview was performed at 12 months evaluating function (BI; Modified Rankin Score, mRS), quality of life (Reintegration into Normal living Scale, RNL), depression (Geriatric Depression Scale, GDS), and fatigue (FIS).Results:We enrolled 522 ischemic stroke patients and 228 (57.6%) survivors completed one-year follow-up. In total, 36.8% endorsed fatigue (59.5% rated one of worst post-stroke symptoms). Linear regression demonstrated younger age was associated with increased fatigue frequency (β=-0.20;p=0.01), duration (β=-0.22;p<0.01), and disability (β=-0.24;p<0.01). Younger patients were more likely to describe fatigue as one of the worst symptoms post-stroke (β=-0.24;p=0.001). Younger patients experienced greater impact on cognitive (β=-0.27;p<0.05) and psychosocial (β=-0.27;p<0.05) function due to fatigue. Fatigue was correlated with depressive symptoms and diminished quality of life. Fatigue occurred without depression as 49.0% of respondents with fatigue as one of their worst symptoms did not have an elevated GDS.Conclusions:Age was the only consistent predictor of fatigue severity at one year. Younger participants experienced increased cognitive and psychosocial fatigue.

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A Randomized Controlled Trial to Study the Effectiveness of Interactive, Virtual Tele-Physiotherapy for Improving Motor Function and Quality of Life in Stroke Patients: A Study Protocol

Journal of Pharmaceutical Research International ◽

10.9734/jpri/2021/v33i51b33530 ◽

2021 ◽

pp. 187-193

Author(s):

Vandana Gudhe ◽

Moh´d Irshad Qureshi ◽

Rakesh Krishna Kovela

Keyword(s):

Quality Of Life ◽

Motor Function ◽

Study Protocol ◽

Controlled Trial ◽

Functional Independence ◽

Stroke Patients ◽

Quality Of Life Scale ◽

Group A ◽

Group B

Introduction: Telephysiotherapy (TPT) is provision of physiotherapy services using telecommunication technology such as audio call or video call to facilitate the physiotherapy management of patients within their own homes. In the absence of which the patients may have to discontinue physiotherapy treatment that may result into poor motor outcomes leading to deterioration of the quality of life (QoL). Methodology: This is a study protocol designed to study the effectiveness of TPT intervention in Stroke patients. The objective is to study whether TPT is effective for Stroke Rehabilitation in improving motor function and quality of life. An exercise protocol will be administered to patients suffering from mild to moderate stroke those grading less than or equal to 4 on a Modified Rankin Scale (mRS=<4). A total 40 patients will be recruited in the study, divided into 2 groups –Group A and Group B, where Group A will receive the exercise therapy through Tele Physiotherapy & Group B will receive Out-Patient-Based (OPD-based) Physiotherapy. Participants of both the groups will be called to the OPD at the baseline and at the end of 6 weeks intervention. The patients shall be assessed at the baseline and at the end of intervention using Fugl-Meyer Assessment (FMA), Dynamic Gait Index (DGI), Functional Independence Measure (FIM) and Stroke Specific Quality Of Life scale (SS-QOL) to evaluate their motor function, gait, functional status and quality of life respectively. Ethical Considerations: Approval from the Institutional Ethics committee of the institute is obtained. Participation in study will be voluntary and only the patients willing to give the written informed consent will be recruited for the study. Results: The results of the study will be published and disseminated in peer-reviewed journals.

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Abstract T P356: Functional Outcomes of the Acute Ischemic Stroke Patient Population

Stroke ◽

10.1161/str.46.suppl_1.tp356 ◽

2015 ◽

Vol 46 (suppl_1) ◽

Author(s):

Laurie Paletz ◽

Pam Roberts ◽

Nili Steiner ◽

Betty Robertson ◽

Nicole Wolber ◽

...

Keyword(s):

Quality Of Life ◽

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Recurrent Stroke ◽

Functional Independence ◽

Severe Disability ◽

Stroke Severity ◽

Post Discharge

Background: Stroke is the leading cause of long-term disability and affects 795,000 in the U.S. each year. This study is conducted to enhance knowledge ofoutcomes after an acute ischemic stroke (AIS).Comprehensive Stroke Certification tasks hospitals with expanding knowledge of functional and quality of life outcomes for AIS patients through the early acute and post-acute phase of recovery and examining the effects of stroke severity, functional impairment,discharge destinations, functional independence, and quality of life post discharge. Researchable question: What are most common setbacks after AIS affetcing functional outcome & readmission? Methods: Looked at AIS patients from 12/2012 -12/ 2013 at Cedars-Sina. Of total of 709 patients 318 were contacted by phone. Measures collected by MedTel Outcomes LLC on all AIS patients one month after discharge. This included the Functional Independence Measure and standardized quality of life and participation measures.The median age was 65 years at the time of the stroke. Results: Most common setbacks were recurrent strokes, pneumonia, falls& heart failure.All caused re-hospitalization after stroke. Discharge destinations 30 days post stroke hospitalization were: home independent 144 (43.3%). No significant disability 49 (14.7%), Slight disability 21 (6.3%) Moderate disability 44 ( 13.2%), moderate to severe disability 43 ( 12.9%) and finally severe disability 31( 9.3%). 83.7 % were home without assistance and 1.3 % were in board and care, 15 patients, (4.7 %) had been readmitted for recurrent stroke, 48 patients had fallen since discharge Conclusions: Over 83.7 % of AIS patients were back living in the community at home with over 60 % having slight disability.The long-term outcomes have implications for late secondary and tertiary prevention and creating a model for predictors of these At follow-up, in terms of physical functioning measures,mostpatients were independent in toileting and self-care activities,half were independent in mobility excluding stairs.Data from this study can be used to understand the functional trajectory of recovery based on severity of stroke, discharge destination and other factors. It is important to understand patients’ characteristics to help prevent readmissions.

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Abstract 2472: The Negative Impact of Spasticity on the Health-Related Quality of Life of Stroke Survivors

Stroke ◽

10.1161/str.43.suppl_1.a2472 ◽

2012 ◽

Vol 43 (suppl_1) ◽

Author(s):

Patrick Gillard ◽

Heidi Sucharew ◽

Sepideh Varon ◽

Kathleen Alwell ◽

Charles Moomaw ◽

...

Keyword(s):

Quality Of Life ◽

Ischemic Stroke ◽

Negative Impact ◽

Stroke Severity ◽

Stroke Survivors ◽

Health Related Quality ◽

Stroke Patients ◽

Related Quality ◽

Health Related

Background: Spasticity can lead to numerous symptomatic and functional problems that can cause substantial disability. No published studies have quantified the independent effect spasticity has on the health-related quality of life (HRQoL) of stroke survivors. Objective: To assess the hypothesis that spasticity has a negative impact on HRQoL among stroke survivors. Design: In 2005, as part of the Greater Cincinnati/Northern Kentucky Stroke Study, a cohort of 460 ischemic stroke patients were interviewed during hospitalization and then followed over time. Detailed in-person interviews and medical record abstractions were undertaken during the early post-stroke period to capture key information about demographics; pre-stroke level of functioning; social, family, and medical histories; medications; laboratory results; and stroke severity. Follow-up interviews at 3 months, 1 year, and 2 years gathered information on HRQoL as measured by the Short Form-12 (SF-12), EuroQol-5D (EQ-5D), and Stroke Specific Quality of Life (SSQOL). SF-12 scores are divided into mental (MCS) and physical (PCS) components that range from 0 to 100, with higher scores indicating better health. EQ-5D scores range from 0 (death) to 1 (perfect health). SSQOL scores are stroke specific and range between 0 and 5, with lower scores indicating better HRQoL. HRQoL differences between stroke survivors with and without spasticity (as reported by the patient) were cross-sectionally compared using generalized linear models, adjusting for age, race, stroke severity, pre-stroke function, and comorbidities. Results: Of the 460 ischemic stroke patients, 328 had spasticity data available at the 3-month interview, with 54 (16%) reporting spasticity following their stroke. The patients included in the 3-month analysis had a mean age of 66 years; 49% were female, and 26% black. Patients who reported spasticity at 3 months had lower mean PCS, EQ-5D index, and SSQOL total score compared with patients without spasticity ( Table ). Similar differences in HRQoL were also observed at year 1 and year 2 (data not shown). Conclusions: We found statistically and clinically meaningful differences in HRQoL between stroke survivors with and without spasticity at 3 months, 1 year, and 2 years following stroke. Clinically, these results suggest an opportunity to improve HRQoL among stroke survivors with effective spasticity management.

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