Changes in the impact of stroke between 3 and 12 months post-stroke, assessed with the Stroke Impact Scale

Background Pre-existing comorbidities can compromise recovery post-stroke. However, the association between comorbidity burden and patient-rated perceived impact has not been systematically investigated. To date, only observer-rated outcome measures of function, disability, and dependence have been used, despite the complexity of the impact of stroke on an individual. Aim Our aim was to explore the association between comorbidity burden and patient-rated perceived impact and overall recovery, within the first-year post-stroke, after adjusting for stroke severity, age, and sex. Methods The sample comprised 177 stroke survivors from 18 hospitals throughout Australia and New Zealand. Comorbidity burden was calculated using the Charlson Comorbidity Index. Perceived impact and recovery were measured by the Stroke Impact Scale index and Stroke Impact Scale overall recovery scale. Quantile regression models were applied to investigate the association between comorbidity burden and perceived impact and recovery. Results Significant negative associations between the Charlson Comorbidity Index and the Stroke Impact Scale index were found at three months. At the .25 quantile, a one-point increase on the Charlson Comorbidity Index was associated with 6.80-points decrease on the Stroke Impact Scale index (95%CI: −11.26, −2.34; p = .003). At the median and .75 quantile, a one-point increase on the Charlson Comorbidity Index was associated, respectively, with 3.58-points decrease (95%CI: −5.62, −1.54; p = .001) and 1.76-points decrease (95%CI: −2.80, −0.73; p = .001) on the Stroke Impact Scale index. At 12 months, at the .25 and .75 quantiles, a one-point increase on the Charlson Comorbidity Index was associated, respectively, with 6.47-points decrease (95%CI: −11.05, −1.89; p = .006) and 1.26-points decrease (95%CI: −2.11, −0.42; p = .004) on the Stroke Impact Scale index. For the Stroke Impact Scale overall recovery measure, significant negative associations were found only at the median at three months and at the .75 quantile at 12 months. Conclusion Comorbidity burden is independently associated with patient-rated perceived impact within the first-year post-stroke. The addition of patient-rated impact measures in personalized rehabilitation may enhance the use of conventional observer-rated outcome measures.

Download Full-text

The impact of a patient-directed activity program on functional outcomes and activity participation after stroke during inpatient rehabilitation—a randomized controlled trial

Clinical Rehabilitation ◽

10.1177/0269215519901153 ◽

2020 ◽

Vol 34 (4) ◽

pp. 504-514

Author(s):

Chad Swank ◽

Molly Trammell ◽

Librada Callender ◽

Monica Bennett ◽

Kara Patterson ◽

...

Keyword(s):

Physical Activity ◽

Randomized Controlled Trial ◽

Functional Outcomes ◽

Controlled Trial ◽

Inpatient Rehabilitation ◽

Post Stroke ◽

Randomized Controlled ◽

Activity Program ◽

Stroke Impact Scale ◽

Impact Scale

Objective: Individuals post stroke are inactive, even during rehabilitation, contributing to ongoing disability and risk of secondary health conditions. Our aims were to (1) conduct a randomized controlled trial to examine the efficacy of a “Patient-Directed Activity Program” on functional outcomes in people post stroke during inpatient rehabilitation and (2) examine differences three months post inpatient rehabilitation discharge. Design: Randomized control trial. Setting: Inpatient rehabilitation facility. Subjects: Patients admitted to inpatient rehabilitation post stroke. Interventions: Patient-Directed Activity Program (PDAP) or control (usual care only). Both groups underwent control (three hours of therapy/day), while PDAP participants were prescribed two additional 30-minute activity sessions/day. Main measures: Outcomes (Stroke Rehabilitation Assessment of Movement Measure, Functional Independence Measure, balance, physical activity, Stroke Impact Scale) were collected at admission and discharge from inpatient rehabilitation and three-month follow-up. Results: Seventy-three patients (PDAP ( n = 37); control ( n = 36)) were included in the primary analysis. Patients in PDAP completed a total of 23.1 ± 16.5 sessions (10.7 ± 8.5 upper extremity; 12.4 ± 8.6 lower extremity) during inpatient rehabilitation. No differences were observed between groups at discharge in functional measures. PDAP completed significantly more steps/day (PDAP = 657.70 ± 655.82, control = 396.17 ± 419.65; P = 0.022). The Stroke Impact Scale showed significantly better memory and thinking (PDAP = 86.2 ± 11.4, control = 80.8 ± 16.7; P = 0.049), communication (PDAP = 93.6 ± 8.3, control = 89.6 ± 12.4; P = 0.042), mobility (PDAP = 62.2 ± 22.5, control = 53.8 ± 21.8; P = 0.038), and overall recovery from stroke (PDAP = 62.1 ± 19.1, control = 52.2 ± 18.7; P = 0.038) for PDAP compared to control. At three months post discharge, PDAP ( n = 11) completed significantly greater physical activity ( P = 0.014; 3586.5 ± 3468.5 steps/day) compared to control ( n = 10; 1760.9 ± 2346.3 steps/day). Conclusion: Functional outcome improvement was comparable between groups; however, PDAP participants completed more steps and perceived greater recovery.

Download Full-text

Cultural adaptation and validation of Stroke Impact Scale 3.0 version in Uganda: A small-scale study

SAGE Open Medicine ◽

10.1177/2050312116671859 ◽

2016 ◽

Vol 4 ◽

pp. 205031211667185 ◽

Cited By ~ 5

Author(s):

Julius T Kamwesiga ◽

Lena von Koch ◽

Anders Kottorp ◽

Susanne Guidetti

Keyword(s):

Rasch Model ◽

Cultural Adaptation ◽

Goodness Of Fit ◽

Hand Function ◽

Small Scale ◽

Culturally Adapted ◽

Stroke Impact Scale ◽

Impact Scale ◽

Patient Reported ◽

The Impact

Background: Knowledge is scarce about the impact of stroke in Uganda, and culturally adapted, psychometrically tested patient-reported outcome measures are lacking. The Stroke Impact Scale 3.0 is recommended, but it has not been culturally adapted and validated in Uganda. Objective: To culturally adapt and determine the psychometric properties of the Stroke Impact Scale 3.0 in the Ugandan context on a small scale. Method: The Stroke Impact Scale 3.0 was culturally adapted to form Stroke Impact Scale 3.0 Uganda ( in English) by involving 25 participants in three different expert committees. Subsequently, Stroke Impact Scale 3.0 Uganda from English to Luganda language was done in accordance with guidelines. The first language in Uganda is English and Luganda is the main spoken language in Kampala city and its surroundings. Translation of Stroke Impact Scale 3.0 Uganda ( both in English and Luganda) was then tested psychometrically by applying a Rasch model on data collected from 95 participants with stroke. Results: Overall, 10 of 59 (17%) items in the eight domains of the Stroke Impact Scale 3.0 were culturally adapted. The majority were 6 of 10 items in the domain Activities of Daily Living, 2 of 9 items in the domain Mobility, and 2 of 5 items in the domain Hand function. Only in two domains, all items demonstrated acceptable goodness of fit to the Rasch model. There were also more than 5% person misfits in the domains Participation and Emotion, while the Communication, Mobility, and Hand function domains had the lowest proportions of person misfits. The reliability coefficient was equal or larger than 0.90 in all domains except the Emotion domain, which was below the set criterion of 0.80 (0.75). Conclusion: The cultural adaptation and translation of Stroke Impact Scale 3.0 Uganda provides initial evidence of validity of the Stroke Impact Scale 3.0 when used in this context. The results provide support for several aspects of validity and precision but also point out issues for further adaptation and improvement of the Stroke Impact Scale.

Download Full-text

Daily Life Upper Limb Activity for Patients with Match and Mismatch between Observed Function and Perceived Activity in the Chronic Phase Post Stroke

Sensors ◽

10.3390/s21175917 ◽

2021 ◽

Vol 21 (17) ◽

pp. 5917

Author(s):

Bea Essers ◽

Marjan Coremans ◽

Janne Veerbeek ◽

Andreas Luft ◽

Geert Verheyden

Keyword(s):

Motor Function ◽

Upper Limb ◽

Clinical Characteristics ◽

Daily Life ◽

Chronic Phase ◽

Chronic Stroke ◽

Good Match ◽

Post Stroke ◽

Stroke Impact Scale ◽

Impact Scale

We investigated actual daily life upper limb (UL) activity in relation to observed UL motor function and perceived UL activity in chronic stroke in order to better understand and improve UL activity in daily life. In 60 patients, we collected (1) observed UL motor function (Fugl-Meyer Assessment (FMA-UE)), (2) perceived UL activity (hand subscale of the Stroke Impact Scale (SIS-Hand)), and (3) daily life UL activity (bilateral wrist-worn accelerometers for 72 h) data. Data were compared between two groups of interest, namely (1) good observed (FMA-UE >50) function and good perceived (SIS-Hand >75) activity (good match, n = 16) and (2) good observed function but low perceived (SIS-Hand ≤75) activity (mismatch, n = 15) with Mann–Whitney U analysis. The mismatch group only differed from the good match group in perceived UL activity (median (Q1–Q3) = 50 (30–70) versus 93 (85–100); p < 0.001). Despite similar observed UL motor function and other clinical characteristics, the affected UL in the mismatch group was less active in daily life compared to the good match group (p = 0.013), and the contribution of the affected UL compared to the unaffected UL for each second of activity (magnitude ratio) was lower (p = 0.022). We conclude that people with chronic stroke with low perceived UL activity indeed tend to use their affected UL less in daily life despite good observed UL motor function.

Download Full-text

Discriminant Validity of the Stroke Impact Scale

Stroke ◽

10.1161/str.32.suppl_1.361-c ◽

2001 ◽

Vol 32 (suppl_1) ◽

pp. 361-361

Author(s):

Sue-Min Lai Dr ◽

Stephanie Studenski Dr ◽

Pamela W Duncan Dr ◽

Subashan Perera Dr

Keyword(s):

Quality Of Life ◽

Discriminant Validity ◽

Community Dwelling ◽

Elderly Subjects ◽

Stroke Patients ◽

P Values ◽

Post Stroke ◽

Stroke Impact Scale ◽

Impact Scale

P123 Purpose: The purpose of this study was to determine the discriminant validity of the Stroke Impact Scale (SIS) by comparing function and quality of life in stroke patients to assessments from stroke-free community dwelling elderly. Methods: The SIS was administered at 90 to 120 days post-stroke to subjects who participated in the Kansas City Stroke Registry (KCSR). The same impact scale was also administered cross-sectionally to community dwelling elderly who were recruited from primary care clinics for participation in an ongoing prospective study of health and function (Merck). All subjects were queried for responses to 64 items of the SIS including eight domains: strength, memory and thinking, emotion, communication, ADL/IADL, mobility, upper extremity, and social participation. Regression analyses were used to examine differences between stroke patients and stroke-free elderly in each of the eight SIS domains while controlling for demographics and comorbidities. Results: One hundred and sixty KCSR subjects and two hundred and forty-three subjects from the Merck study were included in the present analysis. The mean ages were 73±10.1 and 74±5.1, respectively. Gender and race were similar in both groups. The 90-days post-stroke mean Barthel ADL was 80±23 in the stroke patients. Mean scores of all 8 SIS domains were significantly lower in stroke patients than those in the stroke-free community dwelling elderly even after controlling for differences in age and comorbidities (all p values < 0.0001). Mean scores of the 7 SIS domains (except strength), even in stroke patients who had Barthel ADL > 90 at 90-days post-stroke, remained lower than those in the stroke-free community dwelling elderly (p values < 0.01). Conclusion: The SIS was able to discriminate well between stroke patients with disability and stroke-free elderly subjects. Patients who had recovered basic ADLs continued to have residual disability and impaired quality of life when compared to non-stroke patients.

Download Full-text

Gait patterns in ischemic and hemorrhagic post-stroke patients with delayed access to physiotherapy

Hong Kong Physiotherapy Journal ◽

10.1142/s1013702521500074 ◽

2021 ◽

pp. 1-11

Author(s):

Bianca Callegari ◽

Daniela Rosa Garcez ◽

Alex Tadeu Viana da Cruz Júnior ◽

Aline do Socorro Soares Cardoso Almeida ◽

Skarleth Raissa Andrade Candeira ◽

...

Keyword(s):

Biceps Femoris ◽

Stroke Patients ◽

Timed Up And Go ◽

Post Stroke ◽

Leg Muscles ◽

Hemiparetic Gait ◽

Stroke Impact Scale ◽

Impact Scale ◽

Quasi Experimental ◽

Conventional Physiotherapy

Objectives: (1) To assess the effects of a conventional, delayed physiotherapy protocol used by Ischemic Stroke (IS) and Hemorrhagic Stroke (HS) post-stroke patients, in their electromyographic activation patterns during hemiparetic gait; and (2) to study whether this protocol may improve the functional abilities in this population. Methods: This is an observational, descriptive, and analytical quasi-experimental trial. Forty patients with unilateral IS ([Formula: see text]) and HS ([Formula: see text]) stroke were recruited; the stroke involved the motor cortex or sub-cortical areas, and the patients were able to walk independently. Interventions with standard protocols of physiotherapy were carried out. Evaluations (clinical and gait assessment) were performed at the time of admission and at the end of the protocol. Outcome measures include Stroke Impact Scale, Timed Up and Go Test, and gait electromyographic evaluation. Results: Only IS patients (with an average of [Formula: see text] months delayed access to physiotherapy rehabilitation) had improvements in Timed Up and Go Test (change in [Formula: see text][Formula: see text]seg [Formula: see text]) and presented an anticipation of the onset in Upper leg muscles after the intervention. BF ([Formula: see text]), ST ([Formula: see text]), and RF ([Formula: see text]), started their recruitment (onset) earlier at the swing phase of the gait cycle, which is more similar to the normal pattern (grey shadow). IS and HS ([Formula: see text] months since last stroke) patients presented higher electromyographic activation, after physiotherapy, of the posterior leg muscles (gastrocnemius, semitendinosus and biceps femoris) during stance phase ([Formula: see text]). Conclusion: IS patients had improvements after delayed conventional physiotherapy. For HS limited response to intervention was observed.

Download Full-text

Evolution and prediction of mismatch between observed and perceived upper limb function after stroke: a prospective, longitudinal, observational cohort study

BMC Neurology ◽

10.1186/s12883-021-02493-1 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Bea Essers ◽

Annick Van Gils ◽

Christophe Lafosse ◽

Marc Michielsen ◽

Hilde Beyens ◽

...

Keyword(s):

Upper Limb ◽

Inpatient Rehabilitation ◽

Stroke Severity ◽

Good Match ◽

Post Stroke ◽

Upper Limb Function ◽

Stroke Impact Scale ◽

Impact Scale ◽

The Individual ◽

Prospective Longitudinal

Abstract Background A previously shown ‘mismatch’ group of patients with good observed upper limb (UL) motor function but low perceived UL activity at six months post stroke tends to use the affected UL less in daily life than would be expected based on clinical tests, and this mismatch may also be present at 12 months. We aimed to confirm this group in another cohort, to investigate the evolution of this group from six to 12 months, and to determine factors on admission to inpatient rehabilitation and at 6 months that can discriminate between mismatch and good match groups at 12 months. Methods Persons after stroke were recruited on rehabilitation admission and re-assessed at six and 12 months. Observed UL function was measured with the upper extremity subscale of the Fugl-Meyer Assessment (FMA-UE) and perceived UL activity by the hand subscale of the Stroke Impact Scale 3.0 (SIS-Hand). We defined mismatch as good observed UL function (FMA-UE > 50/66) but low perceived activity (SIS-Hand≤75/100). Potential discriminators at admission and 6 months (demographic characteristics, stroke characteristics, UL somatosensory function, cognitive deficits, mental function and activity) were statistically compared for match and mismatch groups at 12 months. Results We included 60 participants (female: 42%) with mean (SD) age of 65 (12) years. We confirmed a mismatch group of 11 (18%) patients at 6 months, which increased to 14 (23%) patients at 12 months. In the mismatch group compared to the good match group at 12 months, patients had a higher stroke severity and more somatosensory impairments on admission and at 6 months. Conclusions We confirmed a group of patients with good observed UL function but low perceived activity both at six and at 12 months post stroke. Assessment of stroke severity and somatosensory impairments on admission into rehabilitation could determine mismatch at 12 months and might warrant intervention. However, large differences in clinical outcomes between patients in the mismatch group indicate the importance of tailoring training to the individual needs.

Download Full-text

Evaluation of the German Version of the Stroke Impact Scale (SIS) using Rasch Analysis

Physikalische Medizin Rehabilitationsmedizin Kurortmedizin ◽

10.1055/s-2005-917869 ◽

2005 ◽

Vol 15 (04) ◽

Author(s):

S Geyh ◽

A Cieza ◽

G Stucki

Keyword(s):

Rasch Analysis ◽

German Version ◽

Stroke Impact Scale ◽

Impact Scale

Download Full-text

Influence of Physical Activity and Socio-Economic Status on Depression and Anxiety Symptoms in Patients after Stroke

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18158058 ◽

2021 ◽

Vol 18 (15) ◽

pp. 8058

Author(s):

Małgorzata Paprocka-Borowicz ◽

Mona Wiatr ◽

Maria Ciałowicz ◽

Wojciech Borowicz ◽

Agnieszka Kaczmarek ◽

...

Keyword(s):

Physical Activity ◽

Physical Therapy ◽

Economic Status ◽

Depression Scale ◽

Post Stroke ◽

Positive Effects ◽

Socio Economic Status ◽

Treatment Of Depression ◽

Post Stroke Depression ◽

The Impact

Stroke is a high-risk factor for depression. Neurological rehabilitation is greatly difficult and often does not include treatment of depression. The post-stroke depression plays an important role in the progress of treatment, health, and the life of the patient. The appropriate treatment of depression could improve the quality of life of the patient and their family. The study aimed to evaluate the impact of physical activity and socio-economic status of the patient on the effectiveness of recovery from depression and the severity of the symptoms of depression. The study was conducted with 40 patients after stroke aged 42–82 years, and included 10 women and 30 men who were hospitalized for two weeks. The severity of depression/anxiety (D/A) symptoms were evaluated two times; at admission and after two weeks of physical therapy. The hospital anxiety and depression scale (HADS) questionnaire was used for this purpose. Socio-economic status was evaluated by several simple questions. It was revealed that physical therapy has a positive influence on mental state. The severity of D/A symptoms after stroke is related to the financial status of the patients (2 = 11.198, p = 0.024). The state of health (2 = 20.57, p = 0.022) and physical fitness (2 = 12.95, p = 0.044) changed the severity of symptoms of anxiety and depressive disorders. The kinesiotherapy in the group of patients with post-stroke depression had positive effects; however, economic and health conditions may influence the prognosis of the disease.

Download Full-text

Recovery of Visuospatial Neglect Subtypes and Relationship to Functional Outcome Six Months After Stroke

Neurorehabilitation and Neural Repair ◽

10.1177/15459683211032977 ◽

2021 ◽

pp. 154596832110329

Author(s):

Margaret J. Moore ◽

Kathleen Vancleef ◽

M. Jane Riddoch ◽

Celine R. Gillebert ◽

Nele Demeyere

Keyword(s):

Functional Outcomes ◽

Stroke Severity ◽

Visuospatial Neglect ◽

Recovery Pattern ◽

Stroke Impact Scale ◽

Impact Scale ◽

Significant Difference ◽

Initial Severity

Background/Objective. This study aims to investigate how complex visuospatial neglect behavioural phenotypes predict long-term outcomes, both in terms of neglect recovery and broader functional outcomes after 6 months post-stroke. Methods. This study presents a secondary cohort study of acute and 6-month follow-up data from 400 stroke survivors who completed the Oxford Cognitive Screen’s Cancellation Task. At follow-up, patients also completed the Stroke Impact Scale questionnaire. These data were analysed to identify whether any specific combination of neglect symptoms is more likely to result in long-lasting neglect or higher levels of functional impairment, therefore warranting more targeted rehabilitation. Results. Overall, 98/142 (69%) neglect cases recovered by follow-up, and there was no significant difference in the persistence of egocentric/allocentric (X2 [1] = .66 and P = .418) or left/right neglect (X2 [2] = .781 and P = .677). Egocentric neglect was found to follow a proportional recovery pattern with all patients demonstrating a similar level of improvement over time. Conversely, allocentric neglect followed a non-proportional recovery pattern with chronic neglect patients exhibiting a slower rate of improvement than those who recovered. A multiple regression analysis revealed that the initial severity of acute allocentric, but not egocentric, neglect impairment acted as a significant predictor of poor long-term functional outcomes (F [9,300] = 4.742, P < .001 and adjusted R2 = .098). Conclusions. Our findings call for systematic neuropsychological assessment of both egocentric and allocentric neglect following stroke, as the occurrence and severity of these conditions may help predict recovery outcomes over and above stroke severity alone.

Download Full-text