Stroke Impact Scale Domains Research Articles

Quality of Life in Patients with Excellent 3-Month Clinical Outcome after First-Ever Ischemic Stroke: A Time to Redefine Excellent Outcome?

Introduction: Ischemic stroke (IS) may have impact on long-term health-related quality of life (HRQoL) even in the patients with good clinical outcome, and tools mostly used for the assessment of outcome may underestimate or not reflect all relevant sequels after IS. We aimed to analyze HRQoL in the patients with excellent outcome after IS. Methods: We analyzed consecutive IS patients enrolled in the prospective FRAILTY study (ClinicalTrials.gov: NCT04839887) with excellent 3-month clinical outcome (score 0–1 in modified Rankin Scale [mRS]). Stroke Impact Scale (SIS) version 3.0 and Hospital Anxiety and Depression Scale (HADS) were used for the HRQoL, anxiety, and depression assessments, and subgroup comparisons were performed according to NIHSS score (0, ≥1), age (50<, ≥50 years), and sex. Results: In total, 158 patients (55.7% men, mean age 60.3 ± 13.4 years) were analyzed, and 72.2% of them had score 0 in mRS. The overall lowest median scores were found in the SIS domain “emotion,” “strength,” and “participation.” Patients with NIHSS ≥1 had lower scores in all SIS domains except “emotions” and “mobility.” Patients ≥50 years had lower score in “mobility” (p = 0.004) and females in domain of “social participation” (p = 0.044). No differences were found among all subgroups in HADS anxiety and depression. Age, NIHSS score, and depression were found negative predictors for the physical domains of HRQoL. Discussion/Conclusions: Despite excellent 3-month clinical outcome after IS, patients had affected substantially their HRQoL, especially those with NIHSS ≥1. Patients ≥50 years had more affected “mobility” and females “social participation.”

Frequency of Central Post-Stroke Pain and Its Impact on Quality of Life

Objective: This study aims to determine the frequency of central post-stroke pain (CPSP) in a patient population with stroke as well as investigating the relationship between CPSP and patients' clinical/demographic characteristics, pain intensity, functional status, and quality of life.&#x0D; Methods: The study included 150 patients, who had a stroke and were aged 18 years and above. Demographic data of the patients, time since onset, and etiology, localization of the cerebral lesion, affected side, ambulation status, and Brunnstrom stages were recorded. Douleur neuropathique 4 questions (DN4) were used to assess the presence of CPSP. Visual Analog Scale (VAS) was used for pain intensity, functional ambulation scale (FAS) was used for ambulation status, Barthel Index (BI) was used for functional status, and the stroke impact scale (SIS) was used for quality of life.&#x0D; Results: The mean age of the patients was 67±11.5 years, 54.7% was male, and 45.3% was female. CPSP was evaluated in 15.3% of patients. There was no significant difference between the affected side of the body and age, gender, time since onset, BI scores, and ambulation status of patients according to their CPSP status (p&gt;0.05). There was no statistically significant difference between SIS sub-parameter scores and the presence of CPSP (p&gt;0.05). In correlation analysis, a significant relationship was found between Barthel Indexes and all SIS domains except memory and emotion (p

Influence of educational status and migration background on the long-term health-related quality of life after stroke.

Acute stroke treatment and secondary prevention have tremendously improved functional outcomes after stroke. However, this does not always imply a likewise improvement in health-related quality of life (HRQoL). Knowledge on factors influencing HRQoL after stroke is still scarce, especially regarding social aspects like the level of education and the presence of migration background. In the present stroke cohort study, participants were interviewed during their hospital stay and completed a postal questionnaire at 3 and 12 months post stroke. Functional outcomes were assessed by the modified Rankin Scale and HRQoL by evaluating the detailed Stroke Impact Scale (SIS). Logistic regression models were used to determine associations between education, migration background and quality of life end-points. A total of 945 (mean age 69 years; 56% male) stroke patients were enrolled. After adjusting for confounders, a lower educational level was associated with worse functional outcomes in the SIS domain 'strength' (odds ratio 2.67, 95% confidence interval 1.6-4.4, p&lt; 0.001). Migration background was associated with worse outcomes in the SIS domain 'emotion' (p= 0.007, odds ratio 1.71, 95% confidence interval 1.2-2.5). Additionally, for female patients worse HRQoL outcomes were found in multiple other SIS domains. Migration background and a lower educational level were significantly associated with lower long-term HRQoL after stroke. These aspects should be considered in targeted rehabilitation programmes and follow-up support of stroke patients.

Changes in Perceived Impact of Stroke on Everyday Life over Five Years in a Rehabilitation Sample that Received an Activity of Daily Living Intervention: A Follow-Up Study.

ObjectiveTo compare changes in the perceived impact of stroke on everyday life over time in a rehabilitation sample that received a client-centred activities of daily living (CADL) intervention or usual ADL (UADL) intervention.DesignLongitudinal follow-up of a randomized controlled trial.MethodsA total of 145 persons with stroke were assigned into CADL or UADL. Groups were assessed using the Stroke Impact Scale (SIS) at 3 months, 12 months and 5 years post-intervention. Changes in SIS domain scores over time were compared within and between groups.ResultsChanges in the impact of stroke over time were not related to which intervention the groups received. There were no significant differences in the SIS domains or stroke recovery between groups at the 3-month, 12-month and 5-year follow-ups. Despite an increased impact of stroke over time in some domains in both groups, both groups perceived a decreased impact of stroke in the Participation domain at 12 months. Perceived participation was sustained at the same level at 12 months as at 5 years in both groups.ConclusionThese findings stress the importance of access to follow-up rehabilitation interventions 1-year post-stroke to enable participation in daily activities. Such follow-up and enablement would support the use of self-management strategies in the performance of persons’ valued activities, which might be difficult to perform, due to, for example, impact on hand function or mobility. The results of this study emphasize the importance of prioritizing participation in activities that are meaningful from a personal perspective.LAY ABSTRACTIn this study, perceived impact of stroke on everyday life over time was compared among 145 persons with stroke who received the client-centred or usual activities of daily living intervention. They were followed up at 3, 12 months and 5-years post-stroke. No differences were found in the impact of stroke over time between groups. Despite increased impact of stroke (indicating more problems) over time in some areas, the groups perceived decreased impact of stroke (less problems) in their participation at 12 months. Perceived participation was sustained at the same level at 12 months as at 5 years in both groups. Findings stress the importance of access to follow-up rehabilitation interventions one-year post-stroke to enable participation in daily activities, and to support the use of self-management strategies to facilitate participation in valued and meaningful activities that might be difficult due to person’s functional limitations.

Abstract WP81: The Association Between Health-related Locus Of Control And Post-stroke Disability, Quality Of Life, And Depression

Introduction: Beliefs regarding ones’ control over their health can lie internally, influenced by their own actions, or externally, controlled by others or due to chance. Objective: To examine the association between health-related locus of control (HRLC) type and post-stroke disability, quality of life, and depression. Methods: This study utilized data from the Discharge Educational Strategies for Reduction of Vascular Events (DESERVE) trial (n=552). Participants were categorized into three groups based on their highest Multidimensional Health Locus of Control (MHLC) score. The Stroke Impact Scale (SIS) was used to assess post-stroke disability and quality of life. Linear regression was used to identify differences in each SIS domain score between the three groups while adjusting for the intervention. Depression was defined as a Center for Epidemiological Studies Depression (CESD) score ≥16. Logistic regression was used to examine differences in depression between the three groups while adjusting for the intervention. Results: Of the 529 participants who completed the MHLC questionnaire at baseline, 179 (33.3%) were categorized into the internal group , 163 (30.8%) into the powerful others group, and 190 (35.9%) into the chance group. Of the 297 participants who completed the CESD questionnaires at 12 months, 163 (54.8%) scored ≥ 16. Participant’s mean scores for each SIS domain are reported in Table 1. For the SIS communication domain, the chance group’s mean score was 3.03 points lower than the powerful others group’s score (SE=1.39, p=.029). There were no statistically significant differences in scores for the other seven SIS domains or for depression between groups (Table 1). Discussion: External HRLC based on chance may be a predictor of communication difficulties in patients post-stroke. However, mean communication scores are skewed. Control beliefs are important in post-stroke recovery. More research is needed to validate these findings.

Are There Differences in Long-Term Functioning and Recovery Between Hemorrhagic and Ischemic Stroke Patients Receiving Rehabilitation?

ObjectivePrevious research suggested better recovery in functioning of patients with hemorrhagic as compared to ischemic stroke. Now that more effective acute treatment for ischemic stroke, i.e. thrombolysis and thrombectomy, has become available, this observational cohort study aimed to examine if current rehabilitation outcomes differ between patients with hemorrhagic and ischemic stroke. Materials and MethodsThe Barthel Index, 4 domains of the Stroke Impact Scale (SIS) and the EuroQol 5Dimensions were completed in all consecutive patients who received stroke rehabilitation at start of rehabilitation and during follow-up (for Barthel Index at discharge, SIS and EuroQol 5D after three and six months). Outcomes and recovery (i.e. change of scores between baseline and last follow-up) were compared between patients with hemorrhagic stroke and ischemic stroke (total and categorized by initial hospital treatment) using the Kruskall Wallis test. In addition, recovery was compared between ischemic and hemorrhagic stroke in multiple regression analyses with bootstrapping. ResultsBaseline functioning did not differ between 117 patients with a hemorrhagic stroke, 118 ischemic stroke patient treated with reperfusion therapy, and 125 ischemic stroke patients without reperfusion therapy. There were no differences in functioning at follow-up nor in recovery concerning the Barthel Index, SIS domains ‘mobility’, ‘communication’, ‘memory and thinking’ and ‘mood and emotions’, and EuroQoL 5D between the three categories. ConclusionsIn a rehabilitation population the recovery and functioning at three or six months did not differ between ischemic stroke patients and hemorrhagic stroke patients, regardless of the hospital treatment they had received.

Contralesional Cathodal Transcranial Direct Current Stimulation Does Not Enhance Upper Limb Function in Subacute Stroke: A Pilot Randomized Clinical Trial.

Transcranial direct current stimulation (tDCS) has the potential to improve upper limb motor outcomes after stroke. According to the assumption of interhemispheric inhibition, excessive inhibition from the motor cortex of the unaffected hemisphere to the motor cortex of the affected hemisphere may worsen upper limb motor recovery after stroke. We evaluated the effects of active cathodal tDCS of the primary motor cortex of the unaffected hemisphere (ctDCSM1UH) compared to sham, in subjects within 72 hours to 6 weeks post ischemic stroke. Cathodal tDCS was intended to inhibit the motor cortex of the unaffected hemisphere and hence decrease the inhibition from the unaffected to the affected hemisphere and enhance motor recovery. We hypothesized that motor recovery would be greater in the active than in the sham group. In addition, greater motor recovery in the active group might be associated with bigger improvements in measures in activity and participation in the active than in the sham group. We also explored, for the first time, changes in cognition and sleep after ctDCSM1UH. Thirty subjects were randomized to six sessions of either active or sham ctDCSM1UH as add-on interventions to rehabilitation. The NIH Stroke Scale (NIHSS), Fugl-Meyer Assessment of Motor Recovery after Stroke (FMA), Barthel Index (BI), Stroke Impact Scale (SIS), and Montreal Cognitive Assessment (MoCA) were assessed before, after treatment, and three months later. In the intent-to-treat (ITT) analysis, there were significant GROUP∗TIME interactions reflecting stronger gains in the sham group for scores in NIHSS, FMA, BI, MoCA, and four SIS domains. At three months post intervention, the sham group improved significantly compared to posttreatment in FMA, NIHSS, BI, and three SIS domains while no significant changes occurred in the active group. Also at three months, NIHSS improved significantly in the sham group and worsened significantly in the active group. FMA scores at baseline were higher in the active than in the sham group. After adjustment of analysis according to baseline scores, the between-group differences in FMA changes were no longer statistically significant. Finally, none of the between-group differences in changes in outcomes after treatment were considered clinically relevant. In conclusion, active CtDCSM1UH did not have beneficial effects, compared to sham. These results were consistent with other studies that applied comparable tDCS intensities/current densities or treated subjects with severe upper limb motor impairments during the first weeks post stroke. Dose-finding studies early after stroke are necessary before planning larger clinical trials.

Abstract P209: Community-Based Outpatient Stroke Rehabilitation Program Achieves Excellent Return to Work Outcomes: Characteristics and Rehabilitation Outcomes of Stroke Survivors Who Return to Work

Background: Return to employment and driving are goals for many stroke survivors. There are few reports of patient centered outcomes like return to work or the characteristics of those who achieve these goals. Methods: Prospective observational study of stroke patients treated between 12/2011-7/2019 in an interdisciplinary outpatient rehabilitation program addressing physical, cognitive/communicative, risk factors, psychosocial, driving and vocational issues. Results: Of 190 consecutive patients,104(55%) were working prior to their stroke. 50% (73% men, 27% women) of those working pre-stroke returned to work upon program completion with 90% returning to their prior job, and 65% at prior hours. 24% of returning workers owned their own business, and 76% had other occupations. Returning workers had average age of 54 years, average NIHSS score of 4(range 0-11), average{mRS} of 2.7 (6% with 1; 25% with 2; 58% with 3; 10% with 4), and 31% were aphasic. 39 suffered ischemic strokes and 13 had hemorrhages. Locations were: 18 Left, 15 Right,11 Bilateral hemisphere, 8 Brainstem). 93% of patients working pre-stroke were driving. 80% who returned to work also resumed driving. Returning workers had average percent improvement in 6” walk and Berg Balance scores of 97% and 50% respectively; this group also improved in all 9 Stroke Impact scale domains with SIS total score improving an average of 22%. In comparison, of those not returning to work 34 had ischemic strokes, 18 had hemorrhages. This group had average age 55.6, average NIHSS score 7.3(range2-16), average {mRS} of 3.3(11% with 2, 54% with 3, 33% with 4, 2% with 5), 42% were aphasic, and 20% resumed driving. Returning workers had average admit Montreal Cognitive Assessment score of 25/30 and Stroke Self Efficacy Score of 85%; with average scores of 21/30 and 71% for those not returning to work. Average length of stay was 4.6(range .5-24) and 7.4(range1.7-18) months for those returning and not returning to work. Other demographic and outcome measures are collected. Conclusions: Despite significant disability, stroke survivors can achieve successful recovery, including return to work and driving. Further study of patients returning to work can help direct rehabilitation efforts for patients with return to work goals.

Different predictors after stroke depending on functional dependency at discharge: a 5-year follow up study

BackgroundLevel of dependency after a stroke is important for long-term outcome in several aspects, but less is known about important predictors for outcome depending on functional dependency. The aim of the current study was to investigate self-perceived outcome and identify possible predictors of strength, participation, and emotional outcome 5 years after stroke based on functional dependency at discharge from hospital.MethodsThis observational cohort study included participants living in Gothenburg that were diagnosed with first ever stroke in 2009 and 2010. Baseline data were gathered from medical charts and the outcome was based on the Stroke Impact Scale (SIS) questionnaire mailed out 5 years post-stroke. Logistic regression identified potential predictors of better strength, participation, and emotional outcome.ResultsA total of 266 participants responded to the SIS. The functionally independent participants at hospital discharge reported significantly better scores in all SIS domains compared to the functionally dependent. For those who were functionally independent, only non-modifiable factors (age, sex, stroke type) were significant predictors of a better outcome. However, for the functionally dependent participants, modifiable factors such as feeling depressed, cardiovascular risk factors, and recurrent stroke were significant predictors of unfavourable outcome.ConclusionsImportant factors for predicting a favourable outcome differed due to the level of functional dependency, and modifiable factors were only present in participants that were functionally dependent at discharge. Prevention, detection, and treatment of modifiable factors give an opportunity to reduce the burden of stroke for those who are most vulnerable.

Virtual Reality Games as an Adjunct in Improving Upper Limb Function and General Health among Stroke Survivors

Virtual reality (VR) games has the potential to improve patient outcomes in stroke rehabilitation. However, there is limited information on VR games as an adjunct to standard physiotherapy in improving upper limb function. This study involved 36 participants in both experimental (n = 18) and control (n = 18) groups with a mean age (SD) of 57 (8.20) and 63 (10.54) years, respectively. Outcome measures were the Fugl-Meyer assessment for upper extremities (FMA-UE), Wolf motor function test (WMFT), intrinsic motivation inventory (IMI), Lawton of instrumental activities of daily living (IADL), and stroke impact scale (SIS) assessed at pre-post intervention. The experimental group had 0.5 h of upper limb (UL) VR games with 1.5 h of standard physiotherapy, and the control group received 2 h of standard physiotherapy. The intervention for both groups was performed once a week for eight consecutive weeks. The results showed a significant time–group interaction effect for IMI (p = 0.001), Lawton IADL (p = 0.01) and SIS domain of communication (p = 0.03). A significant time effect was found in FMA-UE (p = 0.001), WMFT (p = 0.001), Lawton IADL (p = 0.01), and SIS domains; strength, ADL and stroke recovery (p < 0.05). These results indicated an improvement in UL motor ability, sensory function, instrumental ADL, and quality of life in both groups after eight weeks of intervention. However, no significant (p > 0.05) group effect on all the outcome measures was demonstrated. Thus, replacing a portion of standard physiotherapy time with VR games was equally effective in improving UL function and general health compared to receiving only standard physiotherapy among stroke survivors.

A physical activity program is no more effective than standard care at maintaining upper limb activity in community-dwelling people with stroke: secondary outcomes from a randomized trial

Objective: To evaluate whether an 18-month, physical activity coaching program is more effective than standard care in terms of upper-limb activity. Design: A prospective, randomized controlled trial. Setting: Three municipalities in Norway. Population: A total of 380 persons with stroke. Intervention: The intervention group received follow-up visits and coaching on physical activity and exercise each month for 18 months after inclusion, by a physiotherapist. The control group received standard care. Main measures: The primary outcome, in this secondary analysis, was Motor Assessment Scale items 6, 7, and 8. Secondary outcomes were National Institute of Health Stroke Scale item 5, the Stroke Impact Scale domain 7, and the Modified Ashworth Scale in flexion/extension of the elbow. Results: In total, 380 persons with stroke were recruited, with mean (SD) age 72 (11) years, and baseline scores total National Institute of Health Stroke Scale was 1.4 (2.2)/1.6 (2.4) and Motor Assessment Scale items 6, 7 and 8 in the intervention/control group was 5.5 (1.2)/5.5 (1.2), 5.4 (1.4)/5.4 (1.3), and 3.6 (2)/3.5 (2), respectively. There was no significant difference between groups in terms of upper limb function in any of the Motor Assessment Scale items. In this population with minor stroke, upper-limb activity was good at three months post-stroke (74% of the maximum) and remained good 18 months later (77% of maximum). Conclusion: After intervention, there was no difference between the groups in terms of upper-limb activity.

Combined Aerobic Exercise and Task Practice Improve Health-Related Quality of Life Poststroke: A Preliminary Analysis

ObjectiveThe aim of this project was to determine the effects of lower extremity aerobic exercise coupled with upper extremity repetitive task practice (RTP) on health-related quality of life (HRQOL) and depressive symptomology in individuals with chronic stroke. DesignSecondary analysis of data from 2 randomized controlled trials. SettingResearch laboratory. ParticipantsIndividuals (N=40) with chronic stroke. InterventionsParticipants received one of the following interventions: forced exercise+RTP (FE+RTP, n=16), voluntary exercise+RTP (VE+RTP, n=16), or stroke education+RTP (EDU+RTP, n=8). All groups completed 24 sessions, each session lasting 90 minutes. Main Outcome MeasuresThe Center for Epidemiological Studies-Depression Scale (CES-D) and Stroke Impact Scale (SIS) were used to assess depressive symptomology and HRQOL. ResultsThere were no significant group-by-time interactions for any of the SIS domains or composite scores. Examining the individual groups following the intervention, those in the FE+RTP and VE+RTP groups demonstrated significant improvements in the following SIS domains: strength, mobility, hand function, activities of daily living, and the physical composite. In addition, the FE+RTP group demonstrated significant improvements in memory, cognitive composite, and percent recovery from stroke. The HRQOL did not change in the EDU+RTP group. Although CES-D scores improved predominantly for those in the FE+RTP group, these improvements were not statistically significant. Overall, results were maintained at the 4-week follow-up. ConclusionAerobic exercise, regardless of mode, preceding motor task practice may improve HRQOL in patients with stroke. The potential of aerobic exercise to improve cardiorespiratory endurance, motor outcomes, and HRQOL poststroke justifies its use to augment traditional task practice.

The impact of stroke on people living in central Uganda: A descriptive study

BackgroundKnowledge about perceived impact of stroke on everyday life as well as rehabilitation needs after stroke in Uganda is necessary to identify and develop rehabilitation interventions.ObjectivesTo explore and describe clinical characteristics and functioning during the acute or subacute phase and chronic phase, as well as the impact of stroke on everyday life during the chronic phase in stroke survivors in central Uganda.MethodA cross-sectional observational study was conducted on a consecutively included acute or subacute (n = 58) sample and a chronic (n = 62) sample. Face-to-face interviews were conducted to collect demographic information and clinical characteristics. The Scandinavian Stroke Scale (SSS) was used to collect clinical characteristics, assess neurological impairment and define stroke severity. The Barthel Index was used to assess the level of dependence in activities of daily living. In addition, the Stroke Impact Scale (SIS) 3.0 Uganda version was used to assess the impact of stroke in everyday life as perceived by the individuals in the chronic sample receiving rehabilitation.ResultsThe mean age of the acute/subacute sample was 49 years and 81% had moderate or severe stroke. The mean age of the chronic rehabilitation group was 53 years and 58% had mild stroke. Time since onset in the acute sample was between 2 days and 3 weeks, and time since onset for the chronic sample varied between 3 months and 3 years. Strength, hand function and participation were the most impacted SIS domains in the chronic sample.ConclusionPeople with severe and moderate stroke were more likely to be admitted to Mulago Hospital. The mean age in the study sample was lower than that in high-income countries. Further knowledge is needed regarding the impact of stroke to develop guidelines for stroke rehabilitation interventions feasible in the Ugandan healthcare context in both rural and urban areas.

Examination of the relevance of the ICF cores set for stroke by comparing with the Stroke Impact Scale

Purpose: To examine if the International Classification of Functioning (ICF) core set for stoke contains problems that are relevant for the persons living with stroke as expressed in the Stroke Impact Scale (SIS).Methods: Cross-sectional study of 242 persons with previous stroke. The agreement between the perceived problems in the SIS items and problems in the categories of Comprehensive ICF Core Set for stroke were analyzed using percent of agreement and Kappa statistic.Results: The analyses between 57 items of the SIS and 31 second-level categories of the ICF were conducted. The problems in domains of “Mobility”, “Activities of daily living”, “Hand function”, “Strength” in the SIS had moderate agreement when compared to ICF categories. The SIS domains of “Emotion” and “Communication”, as well as some aspects of the “Memory” had slight or fair agreement with corresponding ICF categories. The results of the study suggest that there is acceptable agreement between persons after stroke and health professionals in the physical aspects, but rather poor agreement in the cognitive and emotional aspects of functioning.Conclusions: Health professionals do not fully capture the magnitude of emotional or social problems experienced by persons after stroke when using the ICF Core Set as a framework for evaluation.Implications for RehabilitationThe ICF Core Set for Stroke provides comprehensive list of possible health and health related outcomes for persons after stroke.Problems reported in condition-specific patient-reported outcome scales can be important in decision making in rehabilitation.Patients and health professionals tend to agree more on physical than cognitive problems.Examination of the relevance of the ICF cores set for stroke by comparing with the Stroke Impact Scale.

Correlation of the gait speed with the quality of life and the quality of life classified according to speed-based community ambulation in Thai stroke survivors.

Gait abnormality commonly resulted from stroke which affected patients living and probably quality of life (QOL). To assess the relationship between gait speed and the QOL in Thai stroke patients and to compare the QOL among three patient groups that were categorized by gait speed: i) household ambulators <0.4 m/s, ii) limited community ambulators 0.4-0.8 m/s and iii) community ambulators >0.8 m/s. This was a cross-sectional descriptive research study. The demographic data of 92 stroke patients at Songklanagarind Hospital in Thailand were collected. The gait speed was calculated by the 10 meter walk test. The Thai version of the Stroke Impact Scale (SIS) 3.0 evaluated the QOL of the patients. The gait speed was correlated with the SIS score (r = 0.64, p < 0.001). The relationship between the gait speed and most domains of the SIS (i.e., strength, mobility, hand function, activities of daily living [ADL], emotion, social participation and thinking of recovery) were also statistically significant. The community ambulators had a higher total SIS score (729.8) than the limited community (600.8) or household ambulators (478.8) (p < 0.001). For each SIS domain mentioned above, there were significant mean scores except for emotion in the community ambulators compared with the others. The gait speed was significantly correlated with the physical domains of the QOL in stroke patients. The community ambulators had the highest QOL among the three groups.

Increased work and social engagement is associated with increased stroke specific quality of life in stroke survivors at 3 months and 12 months post-stroke: a longitudinal study of an Australian stroke cohort

Background: There is a relative lack of longitudinal studies investigating stroke-specific outcomes and quality of life (QOL). This study aimed to identify which factors (level of disability, cognitive functioning, depressive symptoms, physical activity, and work and social engagement) were independently associated with each stroke-specific domain of QOL, adjusting for age and gender, at 3 months and 12 months post-stroke in an Australian cohort.Method: Survivors of ischemic stroke were recruited from 18 sites of the STroke imAging pRevention and Treatment (START) longitudinal cohort study. Survivors were assessed at 3 months (n = 185) and 12 months (n = 170) post-stroke using the Stroke Impact Scale (SIS), modified Rankin Scale (mRS), Montreal Cognitive Assessment (MoCA), Montgomery-Asberg Depression Rating Scale, Rapid Assessment of Physical Activity, and Work and Social Adjustment Scale (WSAS).Results: WSAS was independently associated with the SIS domains of: Physical Composite function; Participation; and Perceived Recovery at 3 months and 12 months and SIS domain of Emotion at 12 months post-stroke. The presence of depressive symptoms was independently associated with the SIS domains of: Memory and Thinking; and Emotion at 3 months. At 12 months post-stroke, mRS was independently associated with SIS domain of Physical Composite function and MoCA with SIS domain of Communication.Conclusion: Engaging in work and social activities is an important factor associated with stroke-specific domains of QOL over time. It is recommended that services focus on improving work and social engagement given their importance related to QOL in the first year of recovery post-stroke. Identifying and treating those with depressive symptoms may enhance QOL in the early months post-stroke.Trial registration: START-PrePARE Australian New Zealand Clinical Trials, www.anzctr.org.au, Registry number: ACTRN12610000987066. EXTEND ClinicalTrial.gov identifier: NCT00887328.

The Importance of Patient Involvement in Stroke Rehabilitation.

ObjectiveTo investigate the perceived needs for health services by persons with stroke within the first year after rehabilitation, and associations between perceived impact of stroke, involvement in decisions regarding care/treatment, and having health services needs met.MethodData was collected, through a mail survey, from patients with stroke who were admitted to a university hospital in 2012 and had received rehabilitation after discharge from the stroke unit. The rehabilitation lasted an average of 2 to 4.6 months. The Stroke Survivor Needs Survey Questionnaire was used to assess the participants' perceptions of involvement in decisions on care or treatment and needs for health services in 11 problem areas: mobility, falls, incontinence, pain, fatigue, emotion, concentration, memory, speaking, reading, and sight. The perceived impact of stroke in eight areas was assessed using the Stroke Impact Scale (SIS) 3.0. Eleven logistic regression models were created to explore associations between having health services needs met in each problem area respectively (dependent variable) and the independent variables. In all models the independent variables were: age, sex, SIS domain corresponding to the dependent variable, or stroke severity in cases when no corresponding SIS domain was identified, and involvement in decisions on care and treatment.ResultsThe 63 participants who returned the questionnaires had a mean age of 72 years, 33 were male and 30 were female. Eighty percent had suffered a mild stroke. The number of participants who reported problems varied between 51 (80%, mobility) and 24 (38%, sight). Involvement in decisions on care and treatment was found to be associated with having health services needs met in six problem areas: falls, fatigue, emotion, memory, speaking, and reading.ConclusionsThe results highlight the importance of involving patients in making decisions on stroke rehabilitation, as it appears to be associated with meeting their health services needs.

Effects of Twice-Weekly Intense Aerobic Exercise in Early Subacute Stroke: A Randomized Controlled Trial

ObjectiveTo examine the effects of 12 weeks of twice-weekly intensive aerobic exercise on physical function and quality of life after subacute stroke. DesignRandomized controlled trial. SettingAmbulatory care. ParticipantsPatients (N=56; 28 women) aged ≥50 years who had a mild stroke (98% ischemic) and were discharged to independent living and enrolled 20 days (median) after stroke onset. InterventionsSixty minutes of group aerobic exercise, including 2 sets of 8 minutes of exercise with intensity up to exertion level 14 or 15 of 20 on the Borg rating of perceived exertion scale, twice weekly for 12 weeks (n=29). The nonintervention group (n=27) received no organized rehabilitation or scheduled physical exercise. Main Outcome MeasuresPrimary outcome measures included aerobic capacity on the standard ergometer exercise stress test (peak work rate) and walking distance on the 6-minute walk test (6MWT). Secondary outcome measures included maximum walking speed for 10m, balance on the timed Up and Go (TUG) test and single leg stance (SLS), health-related quality of life on the European Quality of Life Scale (EQ-5D), and participation and recovery after stroke on the Stroke Impact Scale (SIS) version 2.0 domains 8 and 9. Participants were evaluated pre- and postintervention. Patient-reported measures were also evaluated at 6-month follow-up. ResultsThe following improved significantly more in the intervention group (pre- to postintervention): peak work rate (group × time interaction, P=.006), 6MWT (P=.011), maximum walking speed for 10m (P<.001), TUG test (P<.001), SLS right and left (eyes open) (P<.001 and P=.022, respectively), and SLS right (eyes closed) (P=.019). Aerobic exercise was associated with improved EQ-5D scores (visual analog scale, P=.008) and perceived recovery (SIS domain 9, P=.002). These patient-reported improvements persisted at 6-month follow-up. ConclusionsIntensive aerobic exercise twice weekly early in subacute mild stroke improved aerobic capacity, walking, balance, health-related quality of life, and patient-reported recovery.

The stroke impact scale: performance as a quality of life measure in a community-based stroke rehabilitation setting

Purpose: The objective of this study was to assess the psychometric properties of the Stroke Impact Scale (SIS). Methods: Data was derived from a study assessing a community-based stroke rehabilitation program. Patients were administered the SIS and Euroqol-5D (EQ-5D-5L) on admission to the study, and at six month and 12 month follow-up. The psychometric performance of each domain of the SIS was assessed at each time point. Results: A total of 164 patients completed outcome measures at baseline, 108 patients at six months and 37 patients at 12 months. Correlation of the SIS domains with the EQ-5D-5L suggested that the dimensions of health contributing to a patient’s perception of health-related quality of life changes over time. Conclusion: The SIS performed well in a sample of patients undergoing stroke rehabilitation in the community. Our findings suggest that the multidimensionality of the SIS may allow health professionals to track patient progress and tailor rehabilitation interventions to target the dimensions of health that are most important to a patient’s overall health and perceived quality of life over time.Implications for RehabilitationThere is an increased need for valid and reliable measures to evaluate the outcomes of patients recovering from stroke in the community.The Stroke Impact Scale (SIS) measures multiple domains of health and is well-suited for use in patients recovering from stroke in the community.There is a high level of internal consistency in the eight SIS domains with no evidence of floor effects; ceiling effects were noted for several domains.Correlation of the SIS with the Euroqol-5D suggested that the dimensions of health contributing to a patient’s perception of health related quality of life changes over time.

Abstract W MP103: Describing Clinimetric Properties of the Stroke Impact Scale

Background and purpose: The Stroke Impact Scale (SIS) is an eight domain (59 item) quality of life scale prevalent in the literature, a short form with physical function focus (SIS-16) is also described. These stroke specific scales may have utility but we should not assume favorable properties. We examined clinimetrics of SIS and SIS-16. Methods: We used patient-level data contained in the Virtual International Stroke Trial Archive (VISTA). For all patients with SIS/SIS-16 we extracted and standardised corresponding clinical and demographic data. We described internal consistency (Cronbach’s alpha) of scales and component sub-domains. We compared SIS to SIS-16 and described correlations with other outcomes. We compared individual SIS domains to scales measuring similar constructs. Results: Using SIS data, n=332 (mean age 65.7 [SD:11]; mean SIS:61 [SD:11]). Internal consistency of SIS was excellent α:0.93. SIS domains agreed with total SIS, poorest agreement was for emotion α:0.63. SIS correlated with BI (r=0.72, p&lt;0.0001); EQ-5D (r=0.69, p&lt;0.0001) and a visual analogue scale (r=0.58, p&lt;0.0001); agreement with SIS-16: α:0.918. SIS domains correlated with some equivalent scales.(table, *data measured at 4 month post ictus) For SIS-16, n=4310, mean age:68.5 (SD:13); mean SIS-16:64 (SD:32); α:0.98; emotion domain had poorest agreement with total SIS-16 α:0.66. SIS-16 correlated with mRS (-0.87 (p&lt;0.0001) and BI (0.89 (p&lt;0.0001)). Conclusions: SIS and SIS-16 show reasonable, but not perfect, construct and congruent validity. Internal consistency of emotion domain is problematic. High internal consistency, even for SIS-16, suggests redundancy and scope to further shorten SIS while maintaining clinimetric properties.