Death and ADL Dependency After Scoring Zero on the NIHSS: A Swedish Retrospective Registry-Based Study

Association of reperfusion therapy in acute ischemic stroke on PROMs after one year; a registry-based case-control study

BACKGROUND

Patient reported outcome measures (PROMs) could expose meaningful differences but are scarcely investigated in acute stroke trials. We sought to investigate the association of reperfusion treatment after acute ischemic stroke (AIS) on PROMs, 1-year post-stroke.

METHODS

A case-control study was conducted among patients admitted with AIS with PROMs collected after 1 year. PROMs included complete recovery, being able to return to life and activities, cognitive functions, depression, and fatigue. Cases were treated with reperfusion therapy (thrombolysis and/or thrombectomy) and compared to controls within the same cohort not receiving reperfusion therapy, matched for age, sex, the National Institute of Health Stroke Scale (NIHSS) at admission and premorbid modified Rankin Scale (mRS). Adjusted conditional logistic and ordinal regression models were used to investigate the association.

RESULTS

We identified 271 reperfusion treated ischemic stroke patients (59 % men, mean ± SD age of 71 ± 14.5, mean ± SD NIHSS of 8 ± 7, 125 (46 %) with NIHSS ≤5) and 271 matched controls (59 % men, mean ± SD age of 71 ± 14.5, mean ± SD NIHSS of 7 ± 6, 147 (54 %) with NIHSS ≤5). Reperfusion treatment was associated with complete recovery (Odds ratio [OR] 2.19 [95 % CI, 1.36-3.56]), return to life and activities (OR 2.69 [95 % CI, 1.52-4.74]) and less fatigue (OR 0.37 [95 % CI, 0.17-0.80]). The results did not change in analyses restricted to NIHSS ≤5 (complete recovery (OR 1.80 [95 % CI, 1.01-3.24]) or return to prior life and activities (OR 2.57 [95 % CI, 1.16-5.7]).

CONCLUSIONS

Reperfusion treatment was associated with self-reported complete recovery, return to normal life and less fatigue 1-year post-stroke.

Amide Proton Transfer-Weighted MRI, Associations with Clinical Severity and Prognosis in Ischemic Strokes

BACKGROUND

The National Institutes of Health Stroke Scale (NIHSS) and the modified Rankin scale (mRS) scores have important shortcomings. Amide proton transfer-weighted (APTw) imaging might offer more valuable information in ischemic strokes assessment.

PURPOSE

To utilize APTw, apparent diffusion coefficient (ADC), and computed tomography perfusion (CTP) for the assessment of clinical symptom severity and 90-day prognosis in patients diagnosed with ischemic stroke.

STUDY TYPE

Prospective.

SUBJECTS

61 patients (mean age 63.2 ± 9.7 years; 46 males, 15 females) with ischemic strokes were included in the study.

FIELD STRENGTH/SEQUENCE

3T/turbo spin echo (TSE) T1-weighted imaging, T2-weighted imaging, T2-fluid attenuated inversion recovery (T2-FLAIR), diffusion-weighted imaging (DWI), and single-shot TSE APTw imaging.

ASSESSMENT

APTw, ADC, and CTP were used to compare patient subgroups and construct a prognostic nomogram model.

STATISTICAL TESTS

Kolmogorov-Smirnov test, t-test, Mann-Whitney U test, chi-square test, Pearson correlation analysis, multivariate logistic regression analysis, decision curve analysis (DCA), receiver operating characteristic curves (ROCs). The significance threshold was set at P < 0.05.

RESULTS

Correlation analysis revealed that APTw and NIHSS exhibit the highest correlation (r = -0.634, 95% confidence interval [CI] -0.418 to -0.782), surpassing that of ADC and lesion size. Multivariable analysis revealed APTw (odds ratio [OR] 0.905, 95% CI 0.845-0.970), ADC (OR 0.745, 95% CI 0.609-0.911), and infarct core-cerebral blood volume (IC-CBV) (OR 0.547, 95% CI 0.310-0.964) as potential risk factors associated with a poor prognosis. The nomogram model demonstrated the highest predictive efficacy, with an area under the curve (AUC) of 0.960 (95% CI 0.911-0.988), exceeding that of APTw, ADC, and IC-CBV individually.

DATA CONCLUSION

The APTw technique holds potential value in categorizing and managing patients with ischemic stroke, offering guidance for the implementation of clinical treatment strategies.

LEVEL OF EVIDENCE

1 TECHNICAL EFFICACY: Stage 2.

Physical activity and influencing factors in people post stroke or transient ischemic attack across diverse regions in Sweden

Background and purpose

Physical activity (PA) and sedentary behavior are key targets for secondary stroke prevention, yet their characteristics and contributing factors are not well understood. This study aims to explore PA and sedentary behavior in individuals' post-stroke or transient ischemic attack (TIA) and identify factors linked to low PA (≤5,000 steps/day) and prolonged sedentary time (≥8 h/day).

Methods

A cross-sectional study comparing sensor-derived (activPAL) PA and sedentary time among community-dwelling individuals post stroke or TIA residing in diverse geographical regions of Sweden. Multiple logistic regression models were performed to determine potential factors associated with low PA and prolonged sedentary time.

Results

The study included 101 participants post-stroke (n = 68) and TIA (n = 33), with a mean age of 70.5 years (65% female), mostly with no or mild disability (91%), living in metropolitan (69%) and rural (31%) areas of Sweden. Most participants (72%) had ≥ 8 h of sedentary time per day and 38% performed ≤5,000 steps per day. Using a walking aid (OR = 11.43, p = 0.002) was independently associated with low PA, whereas contextual factors; living alone (OR = 3.49, p = 0.029) and living in metropolitan areas (OR = 2.79, p = 0.036), were associated with prolonged sedentary time.

Discussion and conclusions

In this study encompassing people post stroke or TIA from diverse geographical regions across Sweden, PA was associated with mobility status whereas sedentary behavior was associated with contextual factors. The results also showed a large variation in PA highlighting the need for tailored strategies to promote PA post stroke or TIA.

Prediction of long-term functional outcome following different rehabilitation pathways after stroke unit discharge

OBJECTIVE

To investigate whether referral for different types of rehabilitation on discharge from Swedish stroke units can predict functional outcomes at 1 and 5 years after a stroke.

DESIGN

A longitudinal and registry-based study.

SUBJECTS/PATIENTS

A total of 5,118 participants with index stroke in 2011 were followed-up at 1 and 5 years after the stroke.

METHODS

Ordinal logistic regression models were developed to predict the category of functional outcome: independent, dependent, or dead. The primary predictors were planned rehabilitation in a home setting, inpatient rehabilitation, and outpatient rehabilitation, with no planned rehabilitation as the reference category.

RESULTS

Planned outpatient rehabilitation predicted independence (compared with death) at 1 year. Planned rehabilitation in the home setting predicted independence (compared with death) at 1 and 5 years. Compared with other planned pathways, participants planned for inpatient rehabilitation had more severe conditions, and planned inpatient rehabilitation did not predict independence.

CONCLUSION

Planning for outpatient or home-based rehabilitation appeared to lead more effectively to participants achieving independence over the course of 1-5 years. This may have been due to the less severe nature of these participants' conditions, compared with those requiring inpatient rehabilitation.