Redefining Disability: Patient-Reported Outcome Measures After Minor Stroke and Transient Ischemic Attack

Marta Olive-Gadea; David Cano; Marc Rodrigo-Gisbert; Marian Muchada; Estefania Montiel; Maria Baladas; Ester Sanchez-Gavilan; Carolina Paredes; Alvaro Garcia-Tornel; Marta Rubiera; Manuel Requena; Marc Ribo; Carlos A Molina

doi:10.1161/STROKEAHA.122.040409

Redefining Disability: Patient-Reported Outcome Measures After Minor Stroke and Transient Ischemic Attack

Stroke. 2023 Jan;54(1):144-150. doi: 10.1161/STROKEAHA.122.040409. Epub 2022 Oct 27.

Affiliations

¹ Stroke Unit, Neurology Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain (M.O.-G., M.R.-G., M.M., E.M., M.B., E.S.-G., C.P., A.G.-T., M. Rubiera, M. Requena, M. Rico, C.A.M.).
² Vall d'Hebron Institut de Recerca, Barcelona, Spain (D.C.).

PMID: 36300370
DOI: 10.1161/STROKEAHA.122.040409

Abstract

Background: Long-term outcome assessment patients with stroke is not fully captured by usual clinical scales such as the modified Rankin Scale (mRS). Patient-reported outcome measures (PROMs) are standardized and validated assessments that consider clinical outcomes from the patient perspective. We aim to analyze the added value of PROMs in patients with transient ischemic attack and minor stroke.

Methods: We included consecutive patients with minor stroke or transient ischemic attack (National Institutes of Health Stroke Scale score 0-5) from April 2020 to October 2021 that participated in the PROMs-through-App program (NORA, NoraHealth Barcelona Spain). Clinician and self-evaluated outcomes were assessed at 90 days: clinician-evaluated mRS, self-reported mRS, the 10-item patient-reported outcome measures questionnaire global health survey (v1.2), Hospital Anxiety and Depression Scale, and the Fatigue Assessment Scale. We evaluated the acceptability (response rate), reliability (internal consistency), and construct validity (correlation with mRS and between scales) of each questionnaire.

Results: We included 355 patients in the analysis, response rate was patient-reported outcome measures questionnaire 71.3% (253), Hospital Anxiety and Depression Scale 70.7% (251), Fatigue Assessment Scale 71.8% (255), and self-assessed mRS 66.8% (237). PROMS internal consistency was good or excellent, while agreement between clinician and self-reported mRS was fair (k=0.34). Rate of abnormal PROMS scores were as follows (all responders versus clinician-reported mRS score 0-2): patient-reported outcome measures questionnaire mental health (43.1% versus 36.3%), physical health (48.6% versus 43.6%); Hospital Anxiety and Depression Scale-anxiety (21.9% versus 17.7%) and depression (17.1% versus 13.3%); and Fatigue Assessment Scale (40.8% versus 36.4%). PROMs scores correlated with clinician and self-reported mRS at 90 days.

Conclusions: Evaluation of PROMs using a mobile-app-based communication system is a reliable and valid strategy to assess the outcome of patients from their perspective after a mild stroke or transient ischemic attack.

Keywords: ischemic attack, transient; patient; psychometrics; questionnaire; stroke; survivor.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Disability Evaluation
Humans
Ischemic Attack, Transient* / diagnosis
Ischemic Attack, Transient* / therapy
Outcome Assessment, Health Care
Patient Reported Outcome Measures
Reproducibility of Results
Stroke* / diagnosis
Stroke* / psychology
Stroke* / therapy