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December 01, 2015; 85 (22) Article

Quality of life in patients with TIA and minor ischemic stroke

Rajbeer S. Sangha, Fan Z. Caprio, Robert Askew, Carlos Corado, Richard Bernstein, Yvonne Curran, Ilana Ruff, David Cella, Andrew M. Naidech, Shyam Prabhakaran
First published November 4, 2015, DOI: https://doi.org/10.1212/WNL.0000000000002164
Rajbeer S. Sangha
From the Departments of Neurology (R.S.S., F.Z.C., C.C., R.B., Y.C., I.R., A.M.N., S.P.) and Medical Social Sciences (R.A., D.C.), Northwestern University Feinberg School of Medicine, Chicago, IL.
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Fan Z. Caprio
From the Departments of Neurology (R.S.S., F.Z.C., C.C., R.B., Y.C., I.R., A.M.N., S.P.) and Medical Social Sciences (R.A., D.C.), Northwestern University Feinberg School of Medicine, Chicago, IL.
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Robert Askew
From the Departments of Neurology (R.S.S., F.Z.C., C.C., R.B., Y.C., I.R., A.M.N., S.P.) and Medical Social Sciences (R.A., D.C.), Northwestern University Feinberg School of Medicine, Chicago, IL.
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Carlos Corado
From the Departments of Neurology (R.S.S., F.Z.C., C.C., R.B., Y.C., I.R., A.M.N., S.P.) and Medical Social Sciences (R.A., D.C.), Northwestern University Feinberg School of Medicine, Chicago, IL.
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Richard Bernstein
From the Departments of Neurology (R.S.S., F.Z.C., C.C., R.B., Y.C., I.R., A.M.N., S.P.) and Medical Social Sciences (R.A., D.C.), Northwestern University Feinberg School of Medicine, Chicago, IL.
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Yvonne Curran
From the Departments of Neurology (R.S.S., F.Z.C., C.C., R.B., Y.C., I.R., A.M.N., S.P.) and Medical Social Sciences (R.A., D.C.), Northwestern University Feinberg School of Medicine, Chicago, IL.
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Ilana Ruff
From the Departments of Neurology (R.S.S., F.Z.C., C.C., R.B., Y.C., I.R., A.M.N., S.P.) and Medical Social Sciences (R.A., D.C.), Northwestern University Feinberg School of Medicine, Chicago, IL.
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David Cella
From the Departments of Neurology (R.S.S., F.Z.C., C.C., R.B., Y.C., I.R., A.M.N., S.P.) and Medical Social Sciences (R.A., D.C.), Northwestern University Feinberg School of Medicine, Chicago, IL.
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Andrew M. Naidech
From the Departments of Neurology (R.S.S., F.Z.C., C.C., R.B., Y.C., I.R., A.M.N., S.P.) and Medical Social Sciences (R.A., D.C.), Northwestern University Feinberg School of Medicine, Chicago, IL.
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Shyam Prabhakaran
From the Departments of Neurology (R.S.S., F.Z.C., C.C., R.B., Y.C., I.R., A.M.N., S.P.) and Medical Social Sciences (R.A., D.C.), Northwestern University Feinberg School of Medicine, Chicago, IL.
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Citation
Quality of life in patients with TIA and minor ischemic stroke
Rajbeer S. Sangha, Fan Z. Caprio, Robert Askew, Carlos Corado, Richard Bernstein, Yvonne Curran, Ilana Ruff, David Cella, Andrew M. Naidech, Shyam Prabhakaran
Neurology Dec 2015, 85 (22) 1957-1963; DOI: 10.1212/WNL.0000000000002164

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Abstract

Objective: We investigated health-related quality of life (HRQOL) in patients with TIA and minor ischemic stroke (MIS) using Neuro-QOL, a validated, patient-reported outcome measurement system.

Methods: Consecutive patients with TIA or MIS who had (1) modified Rankin Scale (mRS) score of 0 or 1 at baseline, (2) initial NIH Stroke Scale score of ≤5, (3) no acute reperfusion treatment, and (4) 3-month follow-up, were recruited. Recurrent stroke, disability by mRS and Barthel Index, and Neuro-QOL scores in 5 prespecified domains were prospectively recorded. We assessed the proportion of patients with impaired HRQOL, defined as T scores more than 0.5 SD worse than the general population average, and identified predictors of impaired HRQOL using logistic regression.

Results: Among 332 patients who met study criteria (mean age 65.7 years, 52.4% male), 47 (14.2%) had recurrent stroke within 90 days and 41 (12.3%) were disabled (mRS >1 or Barthel Index <95) at 3 months. Any HRQOL impairment was noted in 119 patients (35.8%). In multivariate analysis, age (adjusted odds ratio [OR] 1.02, 95% confidence interval [CI] 1.01–1.04), initial NIH Stroke Scale score (adjusted OR 1.39, 95% CI 1.17–1.64), recurrent stroke (adjusted OR 2.10, 95% CI 1.06–4.13), and proxy reporting (adjusted OR 3.94, 95% CI 1.54–10.10) were independent predictors of impaired HRQOL at 3 months.

Conclusions: Impairment in HRQOL is common at 3 months after MIS and TIA. Predictors of impaired HRQOL include age, index stroke severity, and recurrent stroke. Future studies should include HRQOL measures in outcome assessment, as these may be more sensitive to mild deficits than traditional disability scales.

GLOSSARY

BI=
Barthel Index;
CI=
confidence interval;
DWI=
diffusion-weighted imaging;
HRQOL=
health-related quality of life;
MIS=
minor ischemic stroke;
mRS=
modified Rankin Scale;
NIHSS=
NIH Stroke Scale;
OR=
odds ratio

Footnotes

  • Go to Neurology.org for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.

  • Supplemental data at Neurology.org

  • Received February 25, 2015.
  • Accepted in final form June 29, 2015.
  • © 2015 American Academy of Neurology
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Letters: Rapid online correspondence

  • Reply to "Actual impairment or subjective disability"
    • Shyam Prabhakaran, sprabhak@nm.org
    Submitted January 14, 2016
  • Actual impairment or subjective disability
    • Sameer Sharma, Stroke fellow, Upstate university hospitalSameersharma12@gmail.com
    Submitted January 12, 2016
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