Abstract
Introduction: We aimed to describe the physical and cognitive health of patients with differing levels of post-stroke disability, as defined by modified Rankin Scale (mRS) scores. We also compared cross-sectional correlations between the mRS and the Quality of Life in Neurological Disorders (Neuro-QoL) T-scores to longitudinal correlations of change estimates from each measure. Methods: Mean Neuro-QoL T-scores representing mobility, dexterity, executive function, and cognitive concerns were compared among mRS subgroups. Fixed-effects regression models with robust standard errors estimated correlations among mRS and Neuro-QoL domain scores and correlations among longitudinal change estimates. These change estimates were then compared to distribution-based estimates of minimal clinically important differences. Results: Seven hundred forty-five patients with ischemic stroke (79%) or transient ischemic attack (21%) were enrolled in this longitudinal observational study of post-stroke outcomes. Larger differences in cognitive function were observed in the severe mRS groups (ie, 4-5) while larger differences in physical function were observed in the mild-moderate mRS groups (ie, 0-2). Cross-sectional correlations among mRS and Neuro-QoL T-scores were high (r = 0.61-0.83), but correlations among longitudinal change estimates were weak (r = 0.14-0.44). Conclusions: Findings from this study undermine the validity and utility of the mRS as an outcome measure in longitudinal studies in ischemic stroke patients. Nevertheless, strong correlations indicate that the mRS score, obtained with a single interview, is efficient at capturing important differences in patient-reported quality of life, and is useful for identifying meaningful cross-sectional differences among clinical subgroups.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 1366-1372 |
| Number of pages | 7 |
| Journal | Value in Health |
| Volume | 23 |
| Issue number | 10 |
| DOIs | |
| State | Published - Oct 2020 |
Funding
This research was supported, in part, by the Foundation for Physical Therapy’s Center of Excellence in Physical Therapy Health Services and Health Policy Research and Training Grant, the National Research Service Award postdoctoral fellowship (T-32 HS 000078 and F32HS024366), and the Administration for Community Living’s Switzer Research Fellowship (grant no. 90SF0010). Also, funds were provided by the National Institutes of Health’s National Center for Advancing Translational Sciences ( UL1TR000150 and UL1TR001422 ). Funding also was provided by a National Research Service Award postdoctoral fellowship at the Center for Education in Health Sciences, under an institutional award from the Agency for Healthcare Research and Quality (T-32 HS 000078). A.N. reports funding from the Agency for Healthcare Research and Quality (K18 HS023437) and National Institutes of Health (UL1TR001422). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. The funders played no role in the design, conduct, or reporting of this study.
Keywords
- Neuro-QoL
- ischemic stroke
- modified Rankin Scale
- outcomes assessment
- quality of life
- transient ischemic attack
ASJC Scopus subject areas
- Health Policy
- Public Health, Environmental and Occupational Health
