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Abstract
Objectives (1) Examine 8 patient-reported domains of health across levels of disability compared to the US general population; and (2) identify factors associated with domain scores in patients with ischemic stroke.
Methods Observational cohort study of 1,195 patients in a cerebrovascular clinic from February 17, 2015, to January 27, 2017, who completed Neuro-QoL (Quality of Life in Neurological Disorders) executive function or the following PROMIS (Patient-Reported Outcomes Measurement Information System) scales as part of routine care: physical function, satisfaction with social roles, fatigue, anxiety, depression, pain interference, and sleep disturbance.
Results Mean age was 62 (±15) years, and 81% were white. Median modified Rankin Scale (mRS) score at the clinic visit was 1 (interquartile range 0–2). Percentage of patients with scores meaningfully worse than the general population ranged from 28% (sleep disturbance) to 63% (physical function). Scores were worse in patients with higher mRS levels, although correlation between scores and mRS level varied (sleep disturbance r = 0.16 to physical function r = 0.52). Most affected domains were physical function (T score = 58.8), satisfaction with social roles (T score = 55.4), and executive function (T score = 53.4). Disability, lower income, and female sex were associated with worse scores in multiple domains. Age was associated with worse physical function but lower anxiety, depression, and sleep disturbance.
Conclusions Patients with ischemic stroke reported symptoms in multiple domains that increase to variable degrees at higher levels of disability. Physical function, satisfaction with social roles, and executive function were most affected. This information improves our understanding of the well-being of patients with ischemic stroke and brings attention to the importance of social roles and executive function for stroke survivors.
Glossary
- ICD-9-CM=
- International Classification of Diseases, Ninth Revision, Clinical Modification;
- ICD-10=
- International Classification of Diseases, Tenth Revision;
- ICHOM=
- International Consortium for Health Outcomes Measurement;
- IQR=
- interquartile range;
- mRS=
- modified Rankin Scale;
- Neuro-QoL=
- Quality of Life in Neurological Disorders;
- NIHSS=
- NIH Stroke Scale;
- PHQ-9=
- Patient Health Questionnaire-9;
- PROM=
- patient-reported outcome measure;
- PROMIS=
- Patient-Reported Outcomes Measurement Information System
Footnotes
Go to Neurology.org/N for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.
Editorial, page 717
- Received July 11, 2017.
- Accepted in final form December 18, 2017.
- © 2018 American Academy of Neurology
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