Original Article
Subtle Problems in Activities of Daily Living after a Transient Ischemic Attack or an Apparently Fully Recovered Non-disabling Stroke

https://doi.org/10.1016/j.jstrokecerebrovasdis.2010.05.012Get rights and content

Little is known about the effects on the performance of activities of daily living (ADL) and quality of life (QoL) of transient ischemic attack (TIA) or a nondisabling stroke (NDS) with a full recovery in 72 hours. The present study evaluated ADL performance and QoL, as well as symptoms of anxiety and depression, in patients at 1 and 6 months after a TIA or an NDS. Consecutive hospitalized TIA/NDS patients not requiring rehabilitation were assessed at 1 and 6 months after discharge from a hospital or emergency department. ADL performance was evaluated using the Assessment of Motor and Process Skills (AMPS), QoL was assessed with the Short Form 36 (SF-36), and depression and anxiety symptoms were assessed with the Hospital Anxiety and Depression Scale (HADS). A total of 45 patients completed the follow-up. At 1 month after TIA/NDS, all patients were independent in ADL performance but had AMPS and SF-36 scores below the norm. In addition, 12 patients (27%) had anxiety symptoms, and 9 patients (20%) had symptoms of depression. Although initially considered fully recovered, 23 patients (51%) required rehabilitation after the first follow-up. After 6 months, their AMPS, SF-36, and HADS scores were lower than those of the patients who did not require rehabilitation after the first screening. Half of the patients with a TIA or an NDS who were initially considered fully recovered exhibited ADL limitations, decreased QoL, and symptoms of anxiety or depression after 6 months.

Section snippets

Materials and Methods

Consecutive patients who were admitted between May 2006 and May 2008 to Slotervaart Hospital, Amsterdam with a TIA or an NDS and were discharged to home without the need for rehabilitation treatment were selected for the study. The exclusion criteria were age <18 years and insufficient knowledge of the Dutch language. All assessments were performed at Slotervaart Hospital by two independent occupational therapists. White matter lesions, lacunes, and cortical/subcortical infarcts were assessed

Data Analysis

A difference of 0.3 (± 0.70) logit was assumed to be a clinically relevant difference in the AMPS score when retesting a patient.19 Sample size calculations indicated that we would need 45 patients to detect such a difference with 80% power.

The scores for the assessments are reported as mean and SD, or median and interquartile range in cases of skewed distributions. The paired t test was used to statistically test the follow-up score changes. Published norms for the AMPS,19 SF-36,20 and HADS22,

Results

Between May 2006 and May 2008 we identified 80 eligible patients from a total of 500 hospitalized stroke patients. Of these 80 patients, 22 refused participation for various reasons and 13 did not complete the study. (Figure 1). Table 1 summarizes the characteristics of the participants (N=45) and non-responders (N=35). For the non-responders we only had age, gender, type of stroke, lesion side and stroke incidence. Participants, compared to non-responders, were more often male (62.2% vs 40%),

Discussion

Our findings show that at 1 months and 6 months after sustaining TIA/NDS, patients were experiencing ADL problems as demonstrated by diminished ADL performance, decreased experienced QoL, and symptoms of anxiety and depression. Based on the definition of TIA/NDS, we expected these patients' AMPS, SF-36 and HADS scores to be similar to the norm scores in a healthy population, because the patients were considered fully recovered. Surprisingly, however, at 1 month after TIA/NDS, all patients

Acknowledgment

We thank the occupational therapists M. E. B. T. Verkade and B. M. Berendsen for carrying out the AMPS, SF-36, and HADS tests.

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