(Stroke. 1997;28:740-745.)
© 1997 American Heart Association, Inc.
Articles |
Health Status of Individuals With Mild Stroke
From the Center on Aging, University of Kansas, Kansas City (P.W.D.); Center for Health Policy Research and Education, Duke University, Durham, NC (G.P.S., L.B.G., D.M.); Division of General Medicine (D.M.), Division of Neurology (L.B.G.), and Department of Community and Family Medicine (G.P.S.), Duke University Medical Center, Durham, NC; Department of Public Health Sciences, Bowman Gray School of Medicine, Wake Forest University, Winston-Salem, NC (C.E.); Academic Medical Center Consortium, Rochester, NY (D.M.W.); Richard L. Roudebush Veterans Administration Medical Center, Indianapolis, Ind (M.W.); and the Research Triangle Institute, Research Triangle Park, NC (A.B.).
Correspondence to Pamela W. Duncan, PhD, PT, Center on Aging, University of Kansas Medical Center, 3901 Rainbow Blvd, Kansas City, KS 66160-7117. E-mail pduncan{at}kumc.edu
Background and Purpose Diminished quality of life and limitations in higher levels of physical functioning are often underestimated in stroke and are not fully captured by measures such as the Barthel Index and the Rankin Outcome Scale. This study used additional measures to assess the health status of 304 persons with mild stroke and to compare these individuals with 184 persons with transient ischemic attack and 654 persons without history of stroke/transient ischemic attack but at elevated risk for stroke (asymptomatic group).
Methods Subjects were recruited from the Academic Medical Center Consortium (inpatients), the Cardiovascular Health Study (population-based sample of community-dwelling persons 65 years and older), and United HealthCare (inpatients and outpatients typically younger than 65 years). Subjects were interviewed by telephone or in person to assess activities of daily living (Barthel Index), depression (Center for Epidemiological Studies Depression Scale), health status (MOS-36), and utility for current health state.
Results Most respondents were independent on all Barthel items. The stroke group was more impaired on the MOS-36 than the asymptomatic group but similar to the group with transient ischemic attack. Health-related quality of life was lowest for persons with stroke. While symptom status and Barthel Index score were the strongest predictors of health status, the Barthel Index showed a consistent ceiling effect when compared with the physical function subscale of the MOS-36.
Conclusions The consequences of even mild stroke affect all dimensions of health except pain. Standardized assessment of persons with stroke must evaluate across the entire continuum of health-related functions.
Key Words: cerebral ischemia, transient • stroke assessment • stroke outcome
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