Abstract WP197: Patient-Reported Physical Outcomes Measures in Mild-to-Moderate Stroke and TIA Patients

Abstract

Introduction: Mild-to-moderate stroke and TIA patients are discharged directly home, but may have residual physical disability. The purpose of this study was to compare distributions of three patient-reported outcome measures: PROMIS GPH, Stroke Impact Scale-16 (SIS-16), and simplified modified Rankin (Rankin). Methods: PROMIS GPH includes global ratings of physical activities, physical health, pain and fatigue, SIS-16 includes ADLs, IADLs, and physical activities, and Rankin includes ADLs, IADLs, and overall comparison of function to pre-stroke function. Outcomes were measured at 90-days post-hospital discharge in 1768 stroke and TIA patients discharged directly home in the COMprehensive Post-Acute Stroke Services Study. Ceiling effects (frequency of maximum score) were evaluated for each measure. Differences in SIS-16 and PROMIS GPH scores across levels of Rankin were compared using the Kruskal-Wallis test. Spearman correlation coefficients were calculated between PROMIS GPH, SIS-16, Rankin, and individual items of the PROMIS GPH. Results: At hospital baseline, patients were 68 ± 13 years of age, 50% female, 72% stroke, 28% TIA, and with mean ± SD NIHSS of 2.3 ± 3.6. At 90 days, mean ± SD were 45.8 ± 9.8 for PROMIS GPH, 82.1 ± 19.7 for SIS-16, and 1.2 ± 1.3 for Rankin. Ceiling effects for the PROMIS GPH were (3.1%), SIS-16 (24.8%) and Rankin (38.9%). PROMIS GPH and SIS-16 scores differed significantly (p < 0.0001) across categories of the Rankin. Correlations with Rankin were moderate for SIS-16 (r=-0.64; 95% CI -0.67, -0.62) and PROMIS GPH (r=-0.54; 95% CI -0.58, -0.51). Correlations between SIS-16 and PROMIS GPH items were strong for physical activities (r=0.75; 95% CI 0.63, 0.77) and moderate for physical health (r=0.55; 95% CI 0.52, 0.59), fatigue (r=0.50; 95% CI 0.47, 0.54) and pain (r=0.44; 95% CI 0.40, 0.48). Of 438 patients at SIS-16 ceiling, the mean ± SD for global assessment of physical activities, physical health, pain, and fatigue on a scale of 0-5 were 4.8 ± 0.6, 3.7 ± 0.9, 4.4 ± 0.9, and 4.2 ± 0.7, respectively. Conclusion: PROMIS GPH may better detect physical health differences in mild-to-moderate stroke and TIA patients. Variability in global assessments of physical health, pain, and fatigue contribute to the lower PROMIS GPH ceiling effects.