Abstract 4: Patient-reported And Performance-based Outcomes Separate Independently And Are Associated With Distinct Patterns Of Neuroanatomical Injury After Stroke

Abstract

Introduction: Patient-reported outcome measures (PROMs) provide valuable insights into health status and function, but their relationships with performance-based outcomes remain incompletely understood. Here we compared these two classes of measures using dimensionality-reduction techniques with longitudinal data and examined their relationships with neuroanatomical injury. Methods: Sixty-three adults with hemiparesis were serially assessed (acute, sub-acute, early-chronic, chronic) after stroke using performance-based scales (Upper Extremity Fugl-Meyer, Barthel Index, modified Rankin Scale, Box and Blocks, 9- Hole Peg, Grip Strength) and PROMs (PROMIS-Global Physical, Mental, and General Health, Patient Health Questionnaire-9). Principal component analysis (PCA) was performed at each timepoint to reduce variable dimensionality. Voxel-Based Lesion Symptom Mapping examined the relationship between lesion location and PCA components. Results: Two PCA components accounted for more than 70% of the total variance among outcomes. Performance-based variables loaded onto factor 1 while PROMs loaded onto factor 2. Results were consistent at each timepoint. Performance-based measures were related to injury to subcortical brain regions particularly corticospinal tract (figure, top row), while PROMs were related to injury to cortical areas including intraparietal sulcus and parietal operculum (figure, bottom row). Discussion: A multidimensional battery of assessments scored across the first year post-stroke separated independently into PCA components related to performance-based measure and PROMs. Each component was associated with injury to brain regions concordant with the content of the assessment. These findings emphasize the distinct behavioral elements and neuroanatomical underpinnings for performance-based measures and PROMs after stroke.