Functional and Psychosocial Outcomes 1 year after Mild Stroke

doi:10.1016/j.jstrokecerebrovasdis.2009.02.005

Journal of Stroke and Cerebrovascular Diseases

Volume 19, Issue 1, January 2010, Pages 10-16

https://doi.org/10.1016/j.jstrokecerebrovasdis.2009.02.005 Get rights and content

Background

Mild stroke survivors are generally discharged from acute care within a few days of the stroke event, often without rehabilitation follow-up. We aimed to examine the recovery trajectory for male patients and their wife-caregivers during the 12 months postdischarge.

Methods

A descriptive study was undertaken to examine functional outcomes, quality of life (QOL), depression, caregiver strain, and marital function in a prospective cohort of male survivors of mild stroke and their wife-caregivers during the 12 months postdischarge. Data from each point in time were summarized and repeated measures analyses undertaken. Logistic regression was used to determine which baseline demographic and biopsychosocial variables influenced or predicted marital functioning 1 year postdischarge.

Results

A total of 38 male patients (mean age 63.4 years) and their wife-caregivers (mean age 58.5 years) were examined. The median discharge National Institutes of Health Stroke Scale score was 1.5, modified Rankin Scale score was 1.0, Barthel Index was 100.0, and Stroke Impact Scale-16v2 score was 78.5. The patients' modified Rankin Scale (function) and QOL scores improved significantly over time (F (2) = 4.583, P = .017; and F (6) = 5.632, P < .001, respectively). However, the wife-caregiver QOL scores did not change. Multivariate analysis revealed overall worsening of depression for both the patient and wife-caregivers (F (6, 32) = 3.087, P = .017) and marital function (F (6, 32) = 3.961, P = .004), although the wife-caregivers' perceptions of caregiver strain improved (F (6, 32) = 3.923, P = .007). None of the measured variables were associated with marital functioning 1 year postdischarge.

Conclusions

Despite improvement in patients' functional status, other patient and wife-caregiver psychosocial outcomes during the 12 months postdischarge may be negatively affected. Thus, attention needs to focus on recovery beyond functional outcomes.

Section snippets

Study Design

A prospective cohort study was undertaken to examine and describe changes in patient functional status, patient and wife-caregiver QOL and depression, wife-caregiver strain, and marital dyad functioning during the 12 months after hospital discharge. As the changes in the early discharge period poststroke can be rapid, the measures were repeated monthly for the first 3 months, then at 6, 9, and 12 months postdischarge.

Sample

After obtaining approval from our health research ethics board, study

Results

In all, 48 couples (men with stroke and their wife-caregivers) provided informed consent and were initially enrolled in the study. Those who had missing values on more than 20% of the questionnaires were excluded (2 patients sustained a second stroke and 8 couples declined to participate further or could not be located for follow-up). Thus, the final sample was 38 couples (76 individuals). Data were missing on demographic characteristics and follow-up functional and psychosocial scores for 9 of

Discussion

We examined the impact of mild stroke on functional outcomes, QOL, depression, caregiver burden, and marital function in a cohort of men with mild stroke and their wife-caregivers. Consistent with current literature, the men with mild stroke demonstrated significant improvement in their functional recovery during the follow-up period.5, 6, 7 Much of functional recovery after stroke occurs in the first few months poststroke although full recovery is often tempered by other elements of physical

Conclusions

This study offers new insights into the recovery trajectory of mild stroke for patients and their wife-caregivers. Although the term “mild” implies the consequences of a stroke are negligible, this was not the case in this study and the importance of identifying biopsychosocial characteristics that may impede full recovery and affect the marital relationship should not be underestimated. Our findings imply that psychosocial outcomes are not necessarily related to physical sequelae of mild

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Cited by (63)

Prevalence and Predictors of Fatigue and Neuropsychiatric Symptoms in Patients with Minor Ischemic Stroke
2021, Journal of Stroke and Cerebrovascular Diseases
Citation Excerpt :
Stroke is classified as "minor" when the patient develops few acute neurological symptoms or when there is good functional performance despite the sequelae.6 Patients with minor stroke are expected to return to their pre-stroke functional status relatively quickly, and therefore are unlikely to be strictly followed up by a neurologist.7 Actually, despite the classification, the nomenclature "minor stroke" deserves caution and may underestimate the importance and risks that are naturally linked to this condition.
Patients who are victims of a mild stroke are vulnerable to several invisible and neglected neurological sequelae. In parallel, it is known that fatigue and neuropsychiatric symptoms are common complications after a stroke in general. Our aim was to describe the prevalence and the factors associated with these two outcomes after a minor stroke.
We conducted a prospective observational cohort study that included consecutive patients diagnosed with minor ischemic stroke between 2015 and 2019. Minor stroke was defined as NIHSS < 4 and modified Rankin Scale (mRS) < 2. Patients were followed for 12 months after the index stroke. The primary endpoints included fatigue and neuropsychiatric impairment, which were evaluated with the Fatigue Severity Scale (FSS) and the Hospital Anxiety Depression Scale (HADS), respectively.
A total of sixty patients were followed in our cohort. The mean age was 53.0 (SD 15.0) and 51.7% were male. There were 32 (53.3%) and 25 (41.7%) patients who developed PSF and post-stroke neuropsychiatric symptoms, respectively. The use of antidepressants and statins were associated with post-stroke fatigue, while women and younger patients were more likely to develop neuropsychiatric symptoms after the stroke (p < 0.05). Eighteen (30.0%) patients were diagnosed with both post-stroke fatigue and psychiatric disorders.
Post-stroke fatigue and neuropsychiatric symptoms are prevalent in minor stroke and should be independently addressed as a part of the recovery goal.
Cognition and Quality of Life in Symptomatic Carotid Occlusion
2019, Journal of Stroke and Cerebrovascular Diseases
Citation Excerpt :
The SSQOL consists of questions in the following subgroup domains with ratings ranging from 1 (most impairment) to 5 (no impairment): energy; family roles; language function; mobility; vision; mood; work; personality; self-care; social roles; thinking; and arm function. SSQOL subgroup domains may be examined separately or, as in the current study, the domain scores may be averaged to produce 1 SSQOL score per patient.23 The NIH Stroke Scale (NIHSS) was used to assess deficits from remote stroke.24
Purpose: Carotid occlusion may result in stroke, TIA, and cognitive reductions. Whether cognition predicts quality of life (QOL) for patients with carotid occlusion is unknown. Depression is also known to affect QOL. We examined whether cognition and depression predicted QOL in patients with carotid occlusive disease who have not had revascularization.
Methods: Patients with unilateral carotid occlusion and history of TIA or a remote history of minor stroke were included. Patients underwent exam of memory, language, motor, and executive function skills and completed depression and QOL questionnaires (Center for Epidemiological Studies-Depression [CES-D], Stroke Specific QOL [SSQOL]). Deficits from remote stroke were assessed with the NIH Stroke Scale (NIHSS). Z-scores for cognitive tests were averaged (Cog-Z). The SSQOL scores were averaged across subgroup domains. Analyses of patients with all depression levels were followed by subgroup analyses for patients with minimal depression. Correlation findings were used to select the variables in a regression model to predict SSQOL.
Results: Among 37 patients with all depression levels, QOL was predicted by deficits from remote stroke and depression (F(3, 36) = 21.15, P<.0005; NIHSS Beta = –.392, P = .001; CES-D Beta = –.577, P < .0005). Among 22 patients with minimal depression, QOL was predicted by cognitive and depression scores, (F(2,21) = 7.88, P = .003; Cog-Z Beta = .364, P = .05; CES-D Beta = –.495, P = .01).
Conclusions: In patients with carotid occlusive disease without major stroke and without revascularization, cognitive and depression scores independently predicted QOL. These data demonstrate the clinical relevance of cognitive and mood decline among patients with carotid occlusion.
Interdisciplinary Approaches to Facilitate Return to Driving and Return to Work in Mild Stroke: A Position Paper
2018, Archives of Physical Medicine and Rehabilitation
Adults with mild stroke face substantial challenges resuming valued roles in the community. The term “mild” provides false representation of the lived experience for many adults with mild stroke who may continue to experience persistent challenges and unmet needs. Rehabilitation practitioners can identify and consequently intervene to facilitate improved independence, participation, and quality of life by facilitating function and reducing the burden of lost abilities among adults with mild stroke. The Health and Wellness Task Force identified 2 important, and often interdependent, goals that frequently arise among adults living with mild stroke that must be addressed to facilitate improved community reintegration: (1) return to driving and (2) return to work. Adults with mild stroke may not be receiving adequate rehabilitative services to facilitate community reintegration for several reasons but primarily because current practice models are not designed to meet such needs of this specific population. Thus, the Health and Wellness Task Force convened to review current literature and practice trends to (1) identify opportunities based on the evidence of assessment and interventions, for return to driving and return to work; and (2) identify gaps in the literature that must be addressed to take advantage of the opportunities. Based on findings, the task force proposes a new interdisciplinary practice model for adults with mild stroke who are too often discharged from the hospital to the community without needed services to enable successful return to driving and work.
Development of a Social Functioning Assessment Using Computerized Adaptive Testing for Patients With Stroke
2018, Archives of Physical Medicine and Rehabilitation
To develop a computerized adaptive test of social functioning (Social-CAT) for patients with stroke.
This study contained 2 phases. First, a unidimensional item bank was formed using social-related items with sufficient item fit (ie, infit and outfit mean square [MNSQ]). The social-related items were selected from 3 commonly used patient-reported quality-of-life measures. Items with differential item functioning (DIF) of sex were deleted. Second, we performed simulations to determine the best set of stopping rules with both high reliability and efficiency. The participants' responses to the items were extracted from a previous study.
Rehabilitation wards and departments of rehabilitation/neurology of 5 general hospitals.
Patients (N=263) with stroke (47.1% were inpatients).
Not applicable.
Social-CAT.
The unidimensionality of the 24 selected items was supported (infit and outfit MNSQs =0.8–1.2). One item had DIF of sex and was deleted. The item bank was composed of the remaining 23 items. With the best set of stopping rules (person reliability ≥.90 or limited reliability increased ≤.001), the Social-CAT used on average 10 items to achieve sufficient reliability (average person reliability =.88; 81.0% of the patients with reliability ≥.90).
The Social-CAT appears to be a unidimensional measure with acceptable reliability and efficiency, and it could be useful for both clinicians and patients in time-pressed clinical settings.
Marriage after the transition to stroke: A systematic review
2018, Ageing and Society
Machine Learning Technique Reveals Intrinsic EEG Connectivity Characteristics of Patients With Mild Stroke During Cognitive Task Performing
2024, IEEE Transactions on Cognitive and Developmental Systems

View all citing articles on Scopus

: Dr. Green was supported by a Strategic Training in Health Research Fellowship from the FUTURE Program for Cardiovascular Nurse Scientists, funded by the Canadian Institutes of Health Research, the Heart and Stroke Foundation of Canada, and the Canadian Stroke Network; and a PhD Scholarship from the Alberta Heritage Foundation for Medical Research. The research was supported by the Calgary Stroke Program and the Canadian Association of Neuroscience Nurses. Dr. King is supported by a Health Scholar Award from the Alberta Heritage Foundation for Medical Research.

View full text

Original ArticleFunctional and Psychosocial Outcomes 1 year after Mild Stroke

Background

Methods

Results

Conclusions

Section snippets

Study Design

Sample

Results

Discussion

Conclusions

Lancet

J Stroke Cerebrovasc Dis

Arch Phys Med Rehabil

J Psychiatr Res

Arch Phys Med Rehabil

Arch Phys Med Rehabil

Atlas of heart disease and stroke

A comparison of risk factors and prognosis for transient ischemic attacks and minor ischemic strokes: The Oxfordshire community stroke project

Stroke

A qualitative study of the consequences of 'hidden dysfunctions' one year after a mild stroke in persons < 75 years

Disabil Rehabil

Health status of individuals with mild stroke

Stroke

Measurements of acute cerebral infarction: A clinical examination scale

Stroke

Functional evaluation: The Barthel index

Md State Med J

Cerebrovascular accidents in patients over the age of 60, II: Prognosis

Scott Med J

Stroke Impact Scale-16: A brief assessment of physical function

Neurology

Development of a stroke-specific quality of life scale

Stroke

How to score version 2 of the SF-12 Health Survey® (with a supplement documenting version 1)

Quality Metric Inc. and Health Assessment Lab. Lincoln (RI)

Original Article
Functional and Psychosocial Outcomes 1 year after Mild Stroke

How to score version 2 of the SF-12 Health Survey^® (with a supplement documenting version 1)