Abstract T P286: Comparison of Neuro-QOL Physical Function and modified Rankin Scale in Stroke

Abstract

Introduction: The modified Rankin scale (mRS) is a reliable objective measure of disability and is widely applied in clinical trials. Health-related quality of life (QOL) measurements using Neuro-QOL provide validated measures of patient-reported outcomes. We compared changes in physical function QOL scores with transitions in mRS scores after ischemic stroke or transient ischemic attack (TIA). Methods: From a single-center prospective cohort study, we identified ischemic stroke and TIA patients admitted between August 2012 and April 2013 who survived to 3-month follow-up and underwent mRS and Neuro-QOL outcomes assessments at 1 and 3 months. The mRS was assessed by structured telephone interviews and Neuro-QOL scores using short forms of upper extremity (UE) and lower extremity (LE) function. We used Pearson's coefficient to compare mRS and Neuro-QOL scores and assessed mean changes in Neuro-QOL T-scores across mRS strata and between 1 and 3 months. Results: Three-hundred twelve patients met study criteria (mean age 65.2 years; initial NIHSS score 4; 77.2% ischemic stroke). Strong correlations were noted between mRS and physical function QOL scores at 3-months: mRS-LE: r = -0.74; mRS-UE: r = -0.74. UE and LE QOL scores were 6.1 and 7.1 points lower, respectively, in those with mRS of 1 compared with 0. Within individual patients, a 1 point decrease (improvement) in mRS was associated with increase in UE and LE QOL by 5.6 and 3.3 points while a 1 point increase (worsening) in mRS was associated with a decrease in UE and LE QOL by 4.0 and 7.5 points, respectively. By mRS, 7.5% of patients had worsening by at least 1 point between 1 and 3 months while the proportion with at least 1 standard deviation (10 points) decrease in UE or LE QOL scores was 12.1% and 14.4%, respectively. Conclusions: The mRS correlates well with patient-reported scores of physical function using Neuro-QOL. However, Neuro-QOL offers a complementary tool for assessment of neurological function and may help identify finer grades of functional change over time. Using a continuous measurement of function from the patient perspective may also be more valuable to patients and improve statistical power in clinical trials.