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Reimer C, Ali-Thompson S, Althawadi R, O'Brien N, Hickey A, Moran CN. Reliability of proxy reports on patient reported outcomes measures in stroke: An updated systematic review. J Stroke Cerebrovasc Dis 2024; 33:107700. [PMID: 38570060 DOI: 10.1016/j.jstrokecerebrovasdis.2024.107700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 03/15/2024] [Accepted: 03/26/2024] [Indexed: 04/05/2024] Open
Abstract
OBJECTIVES With the rising global burden of stroke-related morbidity, and increased focus on patient-centered healthcare, patient reported outcome measures (PROMs) are increasingly used to inform healthcare decision-making. Some stroke patients with cognitive or motor impairments are unable to respond to PROMs, so proxies may respond on their behalf; the reliability of which remains unclear. The aim of the study is to update a 2010 systematic review to investigate the inter-rater reliability of proxy respondents answering PROMs for stroke patients. MATERIALS AND METHODS Studies on the reliability of proxy respondents in stroke were searched within CINAHL, Embase, PsycInfo, and WoS databases (01/07/22, 08/07/22). Fifteen studies were included for review. ICC and k-statistic were extracted for PROMs scales and categorized as poor (=0.40), moderate (0.41-0.60), substantial (0.61-0.80), or excellent (>0.80). Bias was assessed using the CCAT. RESULTS Five studies reported PROMs with inter-rater reliability scores ranging from = 0.40 to >0.80. Two studies reported activities of daily living (ADLs) scores ranging from 0.41 to 0.80 and 8 studies reported quality of life (QoL) measures with scores ranging from = 0.40 to >0.80. Subcategories of these scales included physical (ICC/k-statistic 0.41- >0.8), cognitive (ICC/k-statistic 0.40-0.80), communication (ICC/k-statistic <0.4-0.80,) and psychological (ICC/k-statistic <0.40-0.60) measures. CONCLUSIONS Proxy respondents are reliable sources for PROM reports on physical domains in ADLs, PROMs and QoL scales. Proxy reports for measures of communication and psychological domains had greater variability in reliability scores, ranging from poor to substantial; hence, caution should be applied when interpreting proxy reports for these domains.
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Affiliation(s)
- Claire Reimer
- Dept. Health Psychology, RCSI University of Medicine & Health Sciences, Dublin, Ireland.
| | - Sherlissa Ali-Thompson
- Dept. Health Psychology, RCSI University of Medicine & Health Sciences, Dublin, Ireland.
| | - Raseel Althawadi
- Dept. Health Psychology, RCSI University of Medicine & Health Sciences, Dublin, Ireland.
| | - Niall O'Brien
- Teaching & Learning Support, RCSI University of Medicine & Health Sciences, Dublin, Ireland.
| | - Anne Hickey
- Dept. Health Psychology, RCSI University of Medicine & Health Sciences, Dublin, Ireland.
| | - Catherine Nora Moran
- Dept. Health Psychology, RCSI University of Medicine & Health Sciences, Dublin, Ireland.
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2
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Maestrini I, Rocchi L, Diana F, Requena Ruiz M, Elosua-Bayes I, Ribo M, Abdalkader M, Klein P, Gabrieli JD, Alexandre AM, Pedicelli A, Lacidogna G, Ciullo I, Marnat G, Cester G, Broccolini A, Nguyen TN, Tomasello A, Garaci F, Diomedi M, Da Ros V. Outcomes and safety of endovascular treatment from 6 to 24 hours in patients with a pre-stroke moderate disability (mRS 3): a multicenter retrospective study. J Neurointerv Surg 2024:jnis-2024-021634. [PMID: 38811146 DOI: 10.1136/jnis-2024-021634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2024] [Accepted: 04/13/2024] [Indexed: 05/31/2024]
Abstract
BACKGROUND Approximately 30% of patients presenting with acute ischemic stroke (AIS) due to large vessel occlusion have pre-stroke modified Rankin Scale (mRS) scores ≥2. We aimed to investigate the safety and outcomes of endovascular treatment (EVT) in patients with AIS with moderate pre-stroke disability (mRS score 3) in an extended time frame (ie, 6-24 hours from the last time known well). METHODS Data were collected from five centers in Europe and the USA from January 2018 to January 2023 and included 180 patients who underwent EVT in an extended time frame. Patients were divided into two groups of 90 each (Group 1: pre-mRS 0-2; Group 2: pre-mRS 3; 71% women, mean age 80.3±11.9 years). Primary outcomes were: (1) 3-month good clinical outcome (Group 1: mRS 0-2, Group 2: mRS 0-3) and ΔmRS; (2) any hemorrhagic transformation (HT); and (3) symptomatic HT. Secondary outcomes were successful and complete recanalization after EVT and 3-month mortality. RESULTS No between-group differences were found in the 3-month good clinical outcome (26.6% vs 25.5%, P=0.974), any HT (26.6% vs 22%, P=0.733), and symptomatic HT (8.9 vs 4.4%, P=0.232). Unexpectedly, ΔmRS was significantly smaller in Group 2 compared with Group 1 (1.64±1.61 vs 2.97±1.69, P<0.001). No between-group differences were found in secondary outcomes. CONCLUSION Patients with pre-stroke mRS 3 are likely to have similar outcomes after EVT in the extended time frame to those with pre-stroke mRS 0-2, with no difference in safety.
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Affiliation(s)
- Ilaria Maestrini
- Stroke Center, Department of Systems Medicine, University Hospital of Rome Tor Vergata, Rome, Italy
| | - Lorenzo Rocchi
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Francesco Diana
- Interventional Neuroradiology, Vall d'Hebron University Hospital, Barcelona, Spain
- Stroke Research group, Vall d'Hebron Research Institute, Barcelona, Spain
| | - Manuel Requena Ruiz
- Stroke Research group, Vall d'Hebron Research Institute, Barcelona, Spain
- Stroke Unit, Department of Neurology, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Iker Elosua-Bayes
- Stroke Research group, Vall d'Hebron Research Institute, Barcelona, Spain
- Stroke Unit, Department of Neurology, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Marc Ribo
- Stroke Research group, Vall d'Hebron Research Institute, Barcelona, Spain
- Stroke Unit, Department of Neurology, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Mohamad Abdalkader
- Diagnostic and Interventional Neuroradiology, Boston Medical Center, Boston, Massachusetts, USA
| | - Piers Klein
- Diagnostic and Interventional Neuroradiology, Boston Medical Center, Boston, Massachusetts, USA
| | - Joseph D Gabrieli
- Department of Neuroradiology, University Hospital of Padova, Padua, Italy
| | - Andrea M Alexandre
- UOSA Neuroradiologia Interventistica, Fondazione Policlinico Universitario A.Gemelli IRCCS, Rome, Italy
| | - Alessandro Pedicelli
- UOSA Neuroradiologia Interventistica, Fondazione Policlinico Universitario A.Gemelli IRCCS, Rome, Italy
- Catholic University School of Medicine, Institute of Bio-Imaging, Rome, Italy
| | - Giordano Lacidogna
- Stroke Center, Department of Systems Medicine, University Hospital of Rome Tor Vergata, Rome, Italy
| | - Ilaria Ciullo
- Stroke Center, Department of Systems Medicine, University Hospital of Rome Tor Vergata, Rome, Italy
| | - Gaultier Marnat
- Interventional and Diagnostic Neuroradiology, Bordeaux University Hospital, Bordeaux, France
| | - Giacomo Cester
- Department of Neuroradiology, University Hospital of Padova, Padua, Italy
| | - Aldobrando Broccolini
- Neurology Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Thanh N Nguyen
- Diagnostic and Interventional Neuroradiology, Boston Medical Center, Boston, Massachusetts, USA
| | - Alejandro Tomasello
- Interventional Neuroradiology, Vall d'Hebron University Hospital, Barcelona, Spain
- Stroke Research group, Vall d'Hebron Research Institute, Barcelona, Spain
| | - Francesco Garaci
- Neuroradiology Unit, Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Marina Diomedi
- Stroke Center, Department of Systems Medicine, University Hospital of Rome Tor Vergata, Rome, Italy
| | - Valerio Da Ros
- Neuroradiology Unit, Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
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3
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McDonough RV, Ospel JM, Majoie CBLM, Saver JL, White P, Dippel DWJ, Brown SB, Demchuk AM, Jovin TG, Mitchell PJ, Bracard S, Campbell BCV, Muir KW, Hill MD, Guillemin F, Goyal M. Clinical outcome of patients with mild pre-stroke morbidity following endovascular treatment: a HERMES substudy. J Neurointerv Surg 2023; 15:214-220. [PMID: 35210331 DOI: 10.1136/neurintsurg-2021-018428] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 01/20/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND Analyses of the effect of pre-stroke functional levels on the outcome of endovascular therapy (EVT) have focused on the course of patients with moderate to substantial pre-stroke disability. The effect of complete freedom from pre-existing disability (modified Rankin Scale (mRS) 0) versus predominantly mild pre-existing disability/symptoms (mRS 1-2) has not been well delineated. METHODS The HERMES meta-analysis pooled data from seven randomized trials that tested the efficacy of EVT. We tested for a multiplicative interaction effect of pre-stroke mRS on the relationship between treatment and outcomes. Ordinal regression was used to assess the association between EVT and 90-day mRS (primary outcome) in the subgroup of patients with pre-stroke mRS 1-2. Multivariable regression modeling was then used to test the effect of mild pre-stroke disability/symptoms on the primary and secondary outcomes (delta-mRS, mRS 0-2/5-6) compared with patients with pre-stroke mRS 0. RESULTS We included 1764 patients, of whom 199 (11.3%) had pre-stroke mRS 1-2. No interaction effect of pre-stroke mRS on the relationship between treatment and outcome was observed. Patients with pre-stroke mRS 1-2 had worse outcomes than those with pre-stroke mRS 0 (adjusted common OR (acOR) 0.53, 95% CI 0.40 to 0.70). Nonetheless, a significant benefit of EVT was observed within the mRS 1-2 subgroup (cOR 2.08, 95% CI 1.22 to 3.55). CONCLUSIONS Patients asymptomatic/without disability prior to onset have better outcomes following EVT than patients with mild disability/symptoms. Patients with pre-stroke mRS 1-2, however, more often achieve good outcomes with EVT compared with conservative management. These findings indicate that mild pre-existing disability/symptoms influence patient prognosis after EVT but do not diminish the EVT treatment effect.
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Affiliation(s)
- Rosalie V McDonough
- Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg Eppendorf, Hamburg, Germany.,Radiology, University of Calgary, Calgary, Alberta, Canada
| | - Johanna M Ospel
- Neuroradiology, University Hospital Basel, Basel, Switzerland
| | - Charles B L M Majoie
- Radiology and Nuclear Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Jeffrey L Saver
- Neurology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Philip White
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK
| | | | - Scott B Brown
- BRIGHT Research Partners, Mooresville, North Carolina, USA
| | - Andrew M Demchuk
- Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
| | - Tudor G Jovin
- Neurology, Cooper University Hospital, Camden, New Jersey, USA
| | - Peter J Mitchell
- Radiology, The Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Serge Bracard
- Neuroradiology, Université de Lorraine, Nancy, France
| | - Bruce C V Campbell
- Medicine, University of Melbourne, Parkville, Victoria, Australia.,Neurology, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Keith W Muir
- Institute of Neuroscience and Psychology, Queen Elizabeth University Hospital, Glasgow, UK
| | - Michael D Hill
- Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
| | - Francis Guillemin
- Department of Clinical Epidemiology, University Hospital Centre Nancy, Nancy, France
| | - Mayank Goyal
- Radiology, University of Calgary, Calgary, Alberta, Canada
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Ganesh A, Fladt J, Singh N, Goyal M. Efficacy and safety of mechanical thrombectomy in acute stroke patients with pre-morbid disability. Expert Rev Med Devices 2022; 19:641-648. [PMID: 36093630 DOI: 10.1080/17434440.2022.2124109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION – Patients with pre-morbid disability have been generally excluded from randomized controlled trials of mechanical thrombectomy for acute ischemic stroke. However, stroke physicians commonly encounter such patients in practice, and face challenging treatment decisions when caring for them. AREAS COVERED – We review the literature on the safety and efficacy of thrombectomy in patients with pre-morbid disability. Recent clinical-epidemiological studies have highlighted the adverse outcomes that come with each increment of additional post-stroke disability in these patients. Several observational studies - both case series and registry-based studies - have helped demonstrate the comparable safety of thrombectomy in patients with pre-morbid disability as in those without, complementing similar data on thrombolysis. These data also suggest similar rates of successful recanalization, symptomatic intracerebral hemorrhage, and return to pre-stroke level of disability when treated with mechanical thrombectomy, although they have higher mortality. EXPERT OPINION – In the absence of high-quality evidence, we recommend pursuing shared decision-making with patients or family members and being upfront about the uncertain evidence. Available observational data underline the potential for a substantial proportion of these patients to return to their pre-morbid state, do not indicate a greater rate of treatment-related complications, and do not support routinely excluding these patients from thrombectomy.
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Affiliation(s)
- Aravind Ganesh
- Calgary Stroke Program, Department of Clinical Neurosciences, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada.,Hotchkiss Brain Institute and the Mathison Centre for Mental Health Research and Education, University of Calgary, Calgary, Alberta, Canada.,Department of Community Health Sciences, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
| | - Joachim Fladt
- Calgary Stroke Program, Department of Clinical Neurosciences, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada.,Stroke Center and Department of Neurology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Nishita Singh
- Calgary Stroke Program, Department of Clinical Neurosciences, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
| | - Mayank Goyal
- Calgary Stroke Program, Department of Clinical Neurosciences, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada.,Hotchkiss Brain Institute and the Mathison Centre for Mental Health Research and Education, University of Calgary, Calgary, Alberta, Canada.,Department of Radiology, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
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5
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Ganesh A, Fraser JF, Gordon Perue GL, Amin-Hanjani S, Leslie-Mazwi TM, Greenberg SM, Couillard P, Asdaghi N, Goyal M. Endovascular Treatment and Thrombolysis for Acute Ischemic Stroke in Patients With Premorbid Disability or Dementia: A Scientific Statement From the American Heart Association/American Stroke Association. Stroke 2022; 53:e204-e217. [PMID: 35343235 DOI: 10.1161/str.0000000000000406] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Patients with premorbid disability or dementia have generally been excluded from randomized controlled trials of reperfusion therapies such as thrombolysis and endovascular therapy for acute ischemic stroke. Consequently, stroke physicians face treatment dilemmas in caring for such patients. In this scientific statement, we review the literature on acute ischemic stroke in patients with premorbid disability or dementia and propose principles to guide clinicians, clinician-scientists, and policymakers on the use of acute stroke therapies in these populations. Recent clinical-epidemiological studies have demonstrated challenges in our concept and measurement of premorbid disability or dementia while highlighting the significant proportion of the general stroke population that falls under this umbrella, risking exclusion from therapies. Such studies have also helped clarify the adverse long-term clinical and health economic consequences with each increment of additional poststroke disability in these patients, underscoring the importance of finding strategies to mitigate such additional disability. Several observational studies, both case series and registry-based studies, have helped demonstrate the comparable safety of endovascular therapy in patients with premorbid disability or dementia and in those without, complementing similar data on thrombolysis. These data also suggest that such patients have a substantial potential to retain their prestroke level of disability when treated, despite their generally worse prognosis overall, although this remains to be validated in higher-quality registries and clinical trials. By pairing pragmatic and transparent decision-making in clinical practice with an active pursuit of high-quality research, we can work toward a more inclusive paradigm of patient-centered care for this often-neglected patient population.
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6
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Nobels-Janssen E, Postma EN, Abma IL, van Dijk JMC, Haeren R, Schenck H, Moojen WA, den Hertog MH, Nanda D, Potgieser ARE, Coert BA, Verhagen WIM, Bartels RHMA, van der Wees PJ, Verbaan D, Boogaarts HD. Inter-method reliability of the modified Rankin Scale in patients with subarachnoid hemorrhage. J Neurol 2021; 269:2734-2742. [PMID: 34746964 PMCID: PMC8572691 DOI: 10.1007/s00415-021-10880-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 10/26/2021] [Accepted: 10/26/2021] [Indexed: 12/01/2022]
Abstract
Background and objectives The modified Rankin Scale (mRS) is one of the most frequently used outcome measures in trials in patients with an aneurysmal subarachnoid hemorrhage (aSAH). The assessment method of the mRS is often not clearly described in trials, while the method used might influence the mRS score. The aim of this study is to evaluate the inter-method reliability of different assessment methods of the mRS. Methods This is a prospective, randomized, multicenter study with follow-up at 6 weeks and 6 months. Patients aged ≥ 18 years with aSAH were randomized to either a structured interview or a self-assessment of the mRS. Patients were seen by a physician who assigned an mRS score, followed by either the structured interview or the self-assessment. Inter-method reliability was assessed with the quadratic weighted kappa score and percentage of agreement. Assessment of feasibility of the self-assessment was done by a feasibility questionnaire. Results The quadratic weighted kappa was 0.60 between the assessment of the physician and structured interview and 0.56 between assessment of the physician and self-assessment. Percentage agreement was, respectively, 50.8 and 19.6%. The assessment of the mRS through a structured interview and by self-assessment resulted in systematically higher mRS scores than the mRS scored by the physician. Self-assessment of the mRS was proven feasible. Discussion The mRS scores obtained with different assessment methods differ significantly. The agreement between the scores is low, although the reliability between the assessment methods is good. This should be considered when using the mRS in clinical trials. Trial registration www.trialregister.nl; Unique identifier: NL7859. Supplementary Information The online version contains supplementary material available at 10.1007/s00415-021-10880-4.
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Affiliation(s)
- E Nobels-Janssen
- Department of Neurology, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands.
- Department of Neurosurgery, Radboud University Medical Center, PO Box 9101, Nijmegen, 6500 HB, The Netherlands.
| | - E N Postma
- Amsterdam UMC, Department of Neurosurgery, Amsterdam Neuroscience, University of Amsterdam, Amsterdam, The Netherlands
| | - I L Abma
- IQ Healthcare, Radboud University Medical Center, Radboud Institute of Health Sciences, Nijmegen, The Netherlands
| | - J M C van Dijk
- Department of Neurosurgery, University Medical Center Groningen, Groningen, The Netherlands
| | - R Haeren
- Department of Neurosurgery, Maastricht University Medical Center, Maastricht, The Netherlands
| | - H Schenck
- Department of Neurosurgery, Maastricht University Medical Center, Maastricht, The Netherlands
| | - W A Moojen
- Department of Neurosurgery, Haaglanden Medical Center, The Hague, The Netherlands
- Department of Neurosurgery, Leiden University Medical Center, Leiden, The Netherlands
- Department of Neurosurgery, Haga Teaching Hospital, Leiden, The Netherlands
| | - M H den Hertog
- Department of Neurology, Isala Hospital, Zwolle, The Netherlands
| | - D Nanda
- Department of Neurosurgery, Isala Hospital, Zwolle, The Netherlands
| | - A R E Potgieser
- Department of Neurosurgery, University Medical Center Groningen, Groningen, The Netherlands
| | - B A Coert
- Amsterdam UMC, Department of Neurosurgery, Amsterdam Neuroscience, University of Amsterdam, Amsterdam, The Netherlands
| | - W I M Verhagen
- Department of Neurology, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands
| | - R H M A Bartels
- Department of Neurosurgery, Radboud University Medical Center, PO Box 9101, Nijmegen, 6500 HB, The Netherlands
| | - P J van der Wees
- IQ Healthcare, Radboud University Medical Center, Radboud Institute of Health Sciences, Nijmegen, The Netherlands
| | - D Verbaan
- Amsterdam UMC, Department of Neurosurgery, Amsterdam Neuroscience, University of Amsterdam, Amsterdam, The Netherlands
| | - H D Boogaarts
- Department of Neurosurgery, Radboud University Medical Center, PO Box 9101, Nijmegen, 6500 HB, The Netherlands
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7
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Alijanpour S, Mostafazdeh-Bora M, Ahmadi Ahangar A. Different Stroke Scales; Which Scale or Scales Should Be Used? CASPIAN JOURNAL OF INTERNAL MEDICINE 2021; 12:1-21. [PMID: 33680393 PMCID: PMC7919174 DOI: 10.22088/cjim.12.1.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Revised: 02/01/2020] [Accepted: 02/12/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND There has been a considerable development in the clinometric of stroke. But researchers are concerned that some scales are too generic, inherently and the insight may not be provided. The current study was conducted to determine which scale or scales should be used in stroke survivors. METHODS We selected 67 studies which were published between January 2010 and December 2018 from Up to date, CINAHL, ProQuest, Scopus, PubMed, Embase, Medline, Elsevier and Web of Science with MeSH terms. Inclusion criteria were: clinical trials, prospective studies, retrospective cohort studies, or cross-sectional studies; original research in adult human stroke survivors. We excluded the following articles: non-adult population; highly selected studies or treatment studies without incidence data; commentaries, single case reports, review article, editorials and non-English articles or articles without full text available. RESULTS Face Arm Speech Test and Cincinnati Pre-Hospital Stroke Scale scales because it was easy to learn and rapidly administer the recommended dose to use in pre-hospital, but there are not gold standard in stroke diagnosis in Pre-Hospital. National Institutes of Health Stroke Scale valuable in the acute stage for middle cerebral artery, not chronic or long term post stroke outcome. The Barthel Index scores for approximately three weeks could predict activities of daily living disabilities in 6 months. CONCLUSION Every scale has an advantage and a disadvantage and we were not able to introduce the gold standard for each item, but some special scales were used more in the studies, preferred for comparing with other studies to match the research results.
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Affiliation(s)
- Shayan Alijanpour
- Education, Research and Planning Unit, Pre-Hospital Emergency Organization and Emergency Medical Service Center, Babol University of Medical Sciences, Babol, Iran
- Student Research Committee, Faculty of Nursing and Midwifery, Isfahan University of Medical Science, Isfahan, Iran
| | | | - Alijan Ahmadi Ahangar
- Mobility Impairment Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
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8
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Gattellari M, Goumas C, Jalaludin B, Worthington J. Measuring stroke outcomes for 74 501 patients using linked administrative data: System-wide estimates and validation of 'home-time' as a surrogate measure of functional status. Int J Clin Pract 2020; 74:e13484. [PMID: 32003055 DOI: 10.1111/ijcp.13484] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Revised: 01/20/2020] [Accepted: 01/27/2020] [Indexed: 01/06/2023] Open
Abstract
AIMS Administrative data offer cost-effective, whole-of-population stroke surveillance yet the lack of validated measures of functional status is a shortcoming. The number of days spent living at home after stroke ('home-time') is a patient-centred outcome that can be objectively ascertained from administrative data. Population-based validation against both severity and outcome measures and for all subtypes is lacking. We aimed to report representative 'home-time' estimates and validate 'home-time' as a surrogate measure of functional status after stroke. METHODS Stroke hospitalisations from a state-wide census in New South Wales, Australia, from January 1, 2005 to March 31, 2014 were linked to prehospital data, poststroke admissions and deaths. We correlated 90-day 'home-time' with Glasgow Coma Scale (GCS) scores, measured upon a patient's initial contact with paramedics and Functional Independence Measure (FIM) scores, measured upon entry to rehabilitation after the acute hospital stroke admission. Negative binomial regressions identified predictors of 'home-time'. RESULTS Patients with stroke (N = 74 501) spent a median of 53 days living at home 90 days after the event. Median 'home-time' was 60 days after ischaemic stroke, 49 days after subarachnoid haemorrhage and 0 days after intracerebral haemorrhage. GCS and FIM scores significantly correlated with 'home-time' (P < .001). Women spent significantly less time at home compared with men after stroke, although being married increased 'home-time' after ischaemic stroke and subarachnoid haemorrhage. CONCLUSIONS These findings underscore the immediate and adverse impact of stroke. 'Home-time' measured using administrative data is a robust, replicable and valid patient-centred outcome enabling inexpensive population-based surveillance and system-wide quality assessment.
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Affiliation(s)
- Melina Gattellari
- Ingham Institute for Applied Medical Research, Sydney, NSW, Australia
- Department of Neurology, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Chris Goumas
- Ingham Institute for Applied Medical Research, Sydney, NSW, Australia
- School of Public Health, The University of Sydney, Sydney, NSW, Australia
| | - Bin Jalaludin
- Ingham Institute for Applied Medical Research, Sydney, NSW, Australia
- Population Health Intelligence, Healthy People and Places Unit, South Western Sydney Local Health District, Sydney, NSW, Australia
- School of Public Health, The University of New South Wales, Sydney, NSW, Australia
| | - John Worthington
- Ingham Institute for Applied Medical Research, Sydney, NSW, Australia
- Department of Neurology, Royal Prince Alfred Hospital, Sydney, NSW, Australia
- South Western Sydney Clinical School, The University of New South Wales, Sydney, NSW, Australia
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9
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An international, consensus-derived Core Outcome Set for Cardiac Arrest effectiveness trials: the COSCA initiative. Curr Opin Crit Care 2020; 25:226-233. [PMID: 30925524 DOI: 10.1097/mcc.0000000000000612] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
PURPOSE OF REVIEW Accurate and relevant assessment is essential to determining the impact of ill-health and the relative benefit of healthcare. This review details the recent development of a core outcome set for cardiac arrest effectiveness trials - the COSCA initiative. RECENT FINDINGS The reported heterogeneity in outcome assessment and a lack of outcome reporting guidance were key triggers for the development of the COSCA. The historical failure of existing research to adequately capture the perspective of survivors and their family members in defining survival is described. Working collaboratively with international stakeholders - including survivors, family members and advocates - as research partners and participants ensured that a range of perspectives were considered throughout all stages of COSCA development. Three core domains and methods of assessment were recommended: survival - at 30 days or hospital discharge; neurological function assessed at 30 days or hospital discharge with the modified Rankin Scale; and health-related quality of life assessed at 90 days (as a minimum) with one of three generic measures. SUMMARY The COSCA recommendation describes a small group of outcomes that should be reported as a minimum across large, randomized clinical effectiveness trials for cardiac arrest.
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COSCA (Core Outcome Set for Cardiac Arrest) in Adults: An Advisory Statement From the International Liaison Committee on Resuscitation. Resuscitation 2018; 127:147-163. [DOI: 10.1016/j.resuscitation.2018.03.022] [Citation(s) in RCA: 114] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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Haywood K, Whitehead L, Nadkarni VM, Achana F, Beesems S, Böttiger BW, Brooks A, Castrén M, Ong ME, Hazinski MF, Koster RW, Lilja G, Long J, Monsieurs KG, Morley PT, Morrison L, Nichol G, Oriolo V, Saposnik G, Smyth M, Spearpoint K, Williams B, Perkins GD. COSCA (Core Outcome Set for Cardiac Arrest) in Adults: An Advisory Statement From the International Liaison Committee on Resuscitation. Circulation 2018; 137:e783-e801. [PMID: 29700122 DOI: 10.1161/cir.0000000000000562] [Citation(s) in RCA: 151] [Impact Index Per Article: 25.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Cardiac arrest effectiveness trials have traditionally reported outcomes that focus on survival. A lack of consistency in outcome reporting between trials limits the opportunities to pool results for meta-analysis. The COSCA initiative (Core Outcome Set for Cardiac Arrest), a partnership between patients, their partners, clinicians, research scientists, and the International Liaison Committee on Resuscitation, sought to develop a consensus core outcome set for cardiac arrest for effectiveness trials. Core outcome sets are primarily intended for large, randomized clinical effectiveness trials (sometimes referred to as pragmatic trials or phase III/IV trials) rather than for pilot or efficacy studies. A systematic review of the literature combined with qualitative interviews among cardiac arrest survivors was used to generate a list of potential outcome domains. This list was prioritized through a Delphi process, which involved clinicians, patients, and their relatives/partners. An international advisory panel narrowed these down to 3 core domains by debate that led to consensus. The writing group refined recommendations for when these outcomes should be measured and further characterized relevant measurement tools. Consensus emerged that a core outcome set for reporting on effectiveness studies of cardiac arrest (COSCA) in adults should include survival, neurological function, and health-related quality of life. This should be reported as survival status and modified Rankin scale score at hospital discharge, at 30 days, or both. Health-related quality of life should be measured with ≥1 tools from Health Utilities Index version 3, Short-Form 36-Item Health Survey, and EuroQol 5D-5L at 90 days and at periodic intervals up to 1 year after cardiac arrest, if resources allow.
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Taylor-Rowan M, Wilson A, Dawson J, Quinn TJ. Functional Assessment for Acute Stroke Trials: Properties, Analysis, and Application. Front Neurol 2018; 9:191. [PMID: 29632511 PMCID: PMC5879151 DOI: 10.3389/fneur.2018.00191] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Accepted: 03/12/2018] [Indexed: 11/13/2022] Open
Abstract
A measure of treatment effect is needed to assess the utility of any novel intervention in acute stroke. For a potentially disabling condition such as stroke, outcomes of interest should include some measure of functional recovery. There are many functional outcome assessments that can be used after stroke. In this narrative review, we discuss exemplars of assessments that describe impairment, activity, participation, and quality of life. We will consider the psychometric properties of assessment scales in the context of stroke trials, focusing on validity, reliability, responsiveness, and feasibility. We will consider approaches to the analysis of functional outcome measures, including novel statistical approaches. Finally, we will discuss how advances in audiovisual and information technology could further improve outcome assessment in trials.
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Affiliation(s)
- Martin Taylor-Rowan
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Alastair Wilson
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Jesse Dawson
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Terence J Quinn
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom
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Ali M, Fulton R, Quinn T, Brady M. How well do standard stroke outcome measures reflect quality of life? A retrospective analysis of clinical trial data. Stroke 2013; 44:3161-5. [PMID: 24052510 DOI: 10.1161/strokeaha.113.001126] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Quality of life (QoL) is important to stroke survivors yet is often recorded as a secondary measure in acute stroke randomized controlled trials. We examined whether commonly used stroke outcome measures captured aspects of QoL. METHODS We examined primary outcomes by National Institutes of Health Stroke Scale (NIHSS), Barthel Index (BI) and modified Rankin Scale (mRS), and QoL by Stroke Impact Scale (SIS) and European Quality of Life Scale (EQ-5D) from the Virtual International Stroke Trials Archive (VISTA). Using Spearman correlations and logistic regression, we described the relationships between QoL mRS, NIHSS, and BI at 3 months, stratified by respondent (patient or proxy). Using χ2 analyses, we examined the mismatch between good primary outcome (mRS ≤1, NIHSS ≤5, or BI ≥95) but poor QoL, and poor primary outcome (mRS ≥3, NIHSS ≥20, or BI ≤60) but good QoL. RESULTS Patient-assessed QoL had a stronger association with mRS (EQ-5D weighted score n=2987, P<0.0001, r=-0.7, r2=0.53; SIS recovery n=2970, P<0.0001, r=-0.71, r2=0.52). Proxy responses had a stronger association with BI (EQ-5D weighted score n=837, P<0.0001, r=0.78, r2=0.63; SIS recovery n=867, P<0.0001, r=0.68, r2=0.48). mRS explained more of the variation in QoL (EQ-5D weighted score=53%, recovery by SIS v3.0=52%) than NIHSS or BI and resulted in fewer mismatches between good primary outcome and poor QoL (P<0.0001, EQ-5D weighted score=8.5%; SIS recovery=10%; SIS-16=4.4%). CONCLUSIONS The mRS seemed to align closely with stroke survivors' interests, capturing more information on QoL than either NIHSS or BI. This further supports its recommendation as a primary outcome measure in acute stroke randomized controlled trials.
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Affiliation(s)
- Myzoon Ali
- From the Nursing, Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University, United Kingdom (M.A., M.B.); and Institute of Cardiovascular and Medical Sciences, University of Glasgow, Western Infirmary, United Kingdom (M.A., R.F., T.Q.)
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Abstract
As stroke care has developed, there has been a need to robustly assess the efficacy of interventions both at the level of the individual stroke survivor and in the context of clinical trials. To describe stroke-survivor recovery meaningfully, more sophisticated measures are required than simple dichotomous end points, such as mortality or stroke recurrence. As stroke is an exemplar disabling long-term condition, measures of function are well suited as outcome assessment. In this review, we will describe functional assessment scales in stroke, concentrating on three of the more commonly used tools: the National Institutes of Health Stroke Scale, the modified Rankin Scale, and the Barthel Index. We will discuss the strengths, limitations, and application of these scales and use the scales to highlight important properties that are relevant to all assessment tools. We will frame much of this discussion in the context of "clinimetric" analysis. As they are increasingly used to inform stroke-survivor assessments, we will also discuss some of the commonly used quality-of-life measures. A recurring theme when considering functional assessment is that no tool suits all situations. Clinicians and researchers should chose their assessment tool based on the question of interest and the evidence base around clinimetric properties.
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Affiliation(s)
- Jennifer K Harrison
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - Katherine S McArthur
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Terence J Quinn
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
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