Persisting Consequences Of Ischemic Stroke After Three Months, Assessed With The Stroke Impact Scale Version 3.0

ABSTRACT:Background:An estimated 20-25% of all strokes occur during sleep and these patients wake up with their deficits. This study evaluated outcomes among patients who woke up with stroke compared to those who were awake at stroke onset.Methods:Using data from the Registry of the Canadian Stroke Network Phases 1 and 2, we compared demographics, clinical data and six-month outcomes between patients with stroke-on-awakening versus stroke-while-awake. Strokes of all types (ischemic stroke, transient ischemic attack, intracerebral hemorrhage and subarachnoid hemorrhage) were included. Standard descriptive statistics, multivariable logistic regression and general linear modeling were applied to the data to compare variables.Results:Among 2,585 stroke patients, 349 (13.5%) woke up with stroke and 2,236 (86.5%) did not. Patients with stroke-on-awakening were more likely to have higher blood pressure and to suffer ischemic stroke, but stroke severity, measured by level of consciousness, did not differ. Mortality both at discharge and at six-month follow-up did not differ between the two cohorts. However, patients with stroke-on-awakening were less likely to return home, and their median Stroke Impact Scale-16 scores were 7.0 points lower compared to those with stroke-while-awake.Conclusions:There are minor demographic and clinical differences between patients with stroke-on-awakening and stroke-while-awake. Functional outcomes are slightly worse among patients with stroke-on-awakening, an effect which was driven by poor outcomes among patients with subarachnoid hemorrhage.

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Abstract W P324: Acute NIHSS Profiles Predict Differential Outcomes After Mild Ischemic Stroke

Stroke ◽

10.1161/str.45.suppl_1.wp324 ◽

2014 ◽

Vol 45 (suppl_1) ◽

Author(s):

Dorothy F Edwards ◽

Hui -Chun Chen ◽

Deirdra G Tiffany ◽

Chelsea S Kidwell ◽

Alexander W Dromerick

Keyword(s):

Ischemic Stroke ◽

Latent Class Analysis ◽

Latent Class ◽

Motor Impairment ◽

Class Analysis ◽

Nihss Score ◽

Sensory Deficits ◽

Differential Outcomes ◽

Stroke Impact Scale ◽

Impact Scale

Background: A NIHSS total score ≤ 5 is a common criteria for mild stroke. Persons with scores in this range are often considered too mild for tPa treatment and not in need of rehabilitation. There may be distinct patterns of stroke symptoms, possibly not all deficits or combination of deficits produce similar levels of disability. Aim: To investigate if patient profiles created by analysis of initial NIHSS item scores predict 90 day and 1 year outcome on the Modified Rankin Scale (mRS) and Stroke Impact Scale (SIS). Methods: Patients with ischemic stroke and initial NIHSS score ≤ 5 enrolled in the PROTECT DC trial were included. Latent class analysis of NIHSS items was used to create discrete symptom profiles: patients with similar item responses were grouped within the same profile group. Logistic regression using profile groups as independent variables predicted 90 day and 1 year mRS scores. Kruskal-Wallace tests examined differences on Stroke Impact Scale (SIS) Participation scores across the groups. Results: 153 participants were included in the latent class analysis, yielding a 3-profile model. Profile A (82 patients, 54%) represented mild strokes with low probability of abnormality on all NIHSS items. Profile B (16 patients, 11%) patients had right-side motor impairment and sensory deficits. Profile C (55 patients, 36%) patients were more likely to have facial palsy and dysarthria. The median NIHSS score decreased from the most severe Profile B (mdn=3.00) to the most mild Profile A (mdn=1.00), with Profile C (mdn=2.00) between the two extremes. Profile B had significantly higher rates (p<.05) of unfavorable outcomes on mRS (mRS ≥ 2) at 90 days (64%) and 1-year (62%). After adjusting for age, sex, premorbid mRS, and comorbidities, Profile B had 6.56 (CI: 1.45-29.72) times and Profile C had 1.77(CI: 0.73-4.27) times higher odds of being disabled then Profile A at 90 days. One year mRS findings were similar. Profile B also presented with lower levels of participation than Profiles A and C for 1-year SIS participation scores. Conclusion: Patients with initial NIHSS scores ≤ 5 with right-side motor weakness and sensory deficits had more unfavorable outcomes. We suggest that mild strokes are not a homogenous group and should not be treated equally in clinical settings.

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Persisting consequences of ischemic stroke after three months, assessed with the Stroke Impact Scale Version 3.0

Neurological Research ◽

10.1080/01616412.2021.2024714 ◽

2022 ◽

pp. 1-8

Author(s):

Mihael Tsalta-Mladenov ◽

Silva Andonova

Keyword(s):

Ischemic Stroke ◽

Stroke Impact Scale ◽

Impact Scale

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Abstract P4: Predictors of Outcomes in Patients With Mild Ischemic Stroke Symptoms: Results From the Mild and Rapidly Improving Stroke Study (mariss)

Stroke ◽

10.1161/str.52.suppl_1.p4 ◽

2021 ◽

Vol 52 (Suppl_1) ◽

Author(s):

Jose G Romano ◽

Hannah Gardener ◽

Iszet Campo-Bustillo ◽

Yosef Khan ◽

Sofie Tai ◽

...

Keyword(s):

Ischemic Stroke ◽

Primary Outcome ◽

Final Diagnosis ◽

Visual Field Defects ◽

Older Individuals ◽

Stroke Impact Scale ◽

Stroke Study ◽

Impact Scale ◽

Index Stroke ◽

Predictors Of Outcomes

Background: Although most strokes present with mild symptoms, these have been poorly represented in clinical trials. The objective is to describe multidimensional outcomes, identify predictors of worse outcomes and explore the effect of thrombolysis in this population. Methods: This prospective observational study included patients with ischemic stroke or TIA presenting with stroke symptoms and a baseline NIHSS 0-5 within 4.5 hours from symptom onset. The primary outcome was a 90-day modified Rankin Scale (mRS) 0-1; secondary outcomes included good outcomes in the Barthel Index, Stroke Impact Scale-16 (SIS-16) and European Quality of Life. Multivariable models were created to determine predictors of outcomes and the effect of alteplase. Results: A total of 1765 participants were included from 100 Get With The Guidelines (GWTG)-Stroke participating hospitals (age 65 + 14, 42% women, final diagnosis ischemic stroke 90%, TIA 10%, 57% received alteplase). At 90 days, 37% were disabled and 25% not independent. Worse outcomes were noted for older individuals, women, non-Hispanic Blacks and Hispanics, Medicaid, smokers, those with diabetes, atrial fibrillation, prior stroke, higher baseline NIHSS, visual field defects, arm and leg weakness. Similar outcomes were noted for the alteplase-treated and the untreated groups. Alteplase treated patients were younger (64 + 13 vs. 67 + 1.4) with a higher NIHSS (2.9 + 1.4 vs. 1.7 + 1.4). After adjusting for age, sex, race-ethnicity, and baseline NIHSS, we did not identify an effect of alteplase on the primary outcome but did find an effect on SIS-16 in the restricted sample of baseline NIHSS 3-5. Very few symptomatic hemorrhages were recorded (3/999). Conclusions: A large proportion of stroke patients presenting with a low NIHSS have a disabled outcome. Baseline predictors of worse outcomes are described. An effect of alteplase on outcomes was not identified in the overall cohort but an indication of efficacy was noted in the NIHSS 3-5 subgroup.

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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

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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.

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Psychometric properties of the short form of the Stroke Impact Scale in German-speaking stroke survivors

Health and Quality of Life Outcomes ◽

10.1186/s12955-021-01826-5 ◽

2021 ◽

Vol 19 (1) ◽

Author(s):

Anna Coppers ◽

Jens Carsten Möller ◽

Detlef Marks

Keyword(s):

Factor Analysis ◽

Psychometric Properties ◽

Short Form ◽

Trial Registration ◽

Cognitive Domain ◽

Retest Reliability ◽

Stroke Impact Scale ◽

Impact Scale ◽

German Speaking ◽

Test Retest Reliability

Abstract Background The short form of the Stroke Impact Scale (SF-SIS) consists of eight questions and provides an overall index of health-related quality of life after stroke. The goal of the study was the evaluation of construct validity, reliability and responsiveness of the SF-SIS for the use in German-speaking stroke patients in rehabilitation. Methods The SF-SIS, the Stroke Impact Scale 2.0 (SIS 2.0), EQ-5D-5L, National Institutes of Health Stroke Scale (NIHSS) and de Morton Mobility Index were assessed in 150 inpatients after stroke, with a second measurement two weeks later for the analyses of responsiveness. In 55 participants, the test–retest-reliability was assessed one week after the first measurement. The study was designed following the recommendations of the COSMIN initiative. Results The correlations of the SF-SIS with the SIS 2.0 (ρ = 0.90), as well as the EQ-5D-5L (ρ = 0.79) were high, as expected. There was adequate discriminatory ability of the SF-SIS index between patients who were less and more severely affected by stroke, as assessed by the NIHSS. Exploratory factor analysis indicated a two-factor structure of the SF-SIS explaining 59.9% of the total variance, providing better model fit in the confirmatory factor analysis than the one-factorial structure. Analyses of test–retest-reliability showed an intraclass correlation coefficient of 0.88 (95% CI 0.75–0.94). Hypotheses concerning responsiveness were not confirmed due to lower correlations between the assessments change scores. Conclusion Results of this analysis of the SF-SIS’s psychometric properties are matching with the validity analysis of the English original version, confirming the high correlations with the Stroke Impact Scale and the EQ-5D-5L. Examination of structural validity did not confirm the presumed unidimensionality of the scale and found evidence of an underlying two-factor solution with a physical and cognitive domain. Sufficient test–retest reliability and internal consistency were found. In addition, this study provides first results for the responsiveness of the German version. Trial registration The study was registered at the German Clinical Trials Register. Trial registration number: DRKS00011933, date of registration: 07.04.2017

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How Much Change in the Stroke Impact Scale-16 Is Important to People Who Have Experienced a Stroke?

Topics in Stroke Rehabilitation ◽

10.1310/tsr1706-477 ◽

2010 ◽

Vol 17 (6) ◽

pp. 477-483 ◽

Cited By ~ 11

Author(s):

George D. Fulk ◽

Miriam Ludwig ◽

Kari Dunning ◽

Sue Golden ◽

Pierce Boyne ◽

...

Keyword(s):

Stroke Impact Scale ◽

Impact Scale

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Frequency and Prognostic Significance of Clinical Fluctuations Before Hospital Arrival in Stroke

Stroke ◽

10.1161/strokeaha.121.034124 ◽

2021 ◽

Author(s):

Jose G. Romano ◽

Hannah Gardener ◽

Eric E. Smith ◽

Iszet Campo-Bustillo ◽

Yosef Khan ◽

...

Keyword(s):

Ischemic Stroke ◽

Prognostic Significance ◽

Final Diagnosis ◽

Qualitative Assessment ◽

Stroke Subtype ◽

Improvement Program ◽

Unique Identifier ◽

Hospital Arrival ◽

Stroke Impact Scale ◽

Index Stroke

Background and Purpose: Clinical fluctuations in ischemic stroke symptoms are common, but fluctuations before hospital arrival have not been previously characterized. Methods: A standardized qualitative assessment of fluctuations before hospital arrival was obtained in an observational study that enrolled patients with mild ischemic stroke symptoms (National Institutes of Health Stroke Scale [NIHSS] score of 0–5) present on arrival to hospital within 4.5 hours of onset, in a subset of 100 hospitals participating in the Get With The Guidelines–Stroke quality improvement program. The number of fluctuations, direction, and the overall improvement or worsening was recorded based on reports from the patient, family, or paramedics. Baseline NIHSS on arrival and at 72 hours (or discharge if before) and final diagnosis and stroke subtype were collected. Outcomes at 90 days included the modified Rankin Scale, Barthel Index, Stroke Impact Scale 16, and European Quality of Life. Prehospital fluctuations were examined in relation to hospital NIHSS change (admission to 72 hours or discharge) and 90-day outcomes. Results: Among 1588 participants, prehospital fluctuations, consisting of improvement, worsening, or both were observed in 35.5%: 25.1% improved once, 5.3% worsened once, and 5.1% had more than 1 fluctuation. Those who improved were less likely and those who worsened were more likely to receive alteplase. Those who improved before hospital arrival had lower change in the hospital NIHSS than those who did not fluctuate. Better adjusted 90-day outcomes were noted in those with prehospital improvement compared to those without any fluctuations. Conclusions: Fluctuations in neurological symptoms and signs are common in the prehospital setting. Prehospital improvement was associated with better 90-day outcomes, controlling for admission NIHSS and alteplase treatment. REGISTRATION: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT 02072681.

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