Deans' stroke musings: Relevance of Cognition and Emotion for Patient-Reported Quality of Life After Stroke in Working Age: An Observational Cohort Study

Changing stroke rehab and research worldwide now.Time is Brain! trillions and trillions of neurons that DIE each day because there are NO effective hyperacute therapies besides tPA(only 12% effective). I have 523 posts on hyperacute therapy, enough for researchers to spend decades proving them out. These are my personal ideas and blog on stroke rehabilitation and stroke research. Do not attempt any of these without checking with your medical provider. Unless you join me in agitating, when you need these therapies they won't be there.

What this blog is for:

My blog is not to help survivors recover, it is to have the 10 million yearly stroke survivors light fires underneath their doctors, stroke hospitals and stroke researchers to get stroke solved. 100% recovery. The stroke medical world is completely failing at that goal, they don't even have it as a goal. Shortly after getting out of the hospital and getting NO information on the process or protocols of stroke rehabilitation and recovery I started searching on the internet and found that no other survivor received useful information. This is an attempt to cover all stroke rehabilitation information that should be readily available to survivors so they can talk with informed knowledge to their medical staff. It lays out what needs to be done to get stroke survivors closer to 100% recovery. It's quite disgusting that this information is not available from every stroke association and doctors group.

Thursday, April 28, 2022

Relevance of Cognition and Emotion for Patient-Reported Quality of Life After Stroke in Working Age: An Observational Cohort Study

You wouldn't have to do quality of life research if you had 100% recovery protocols. Focus on the correct research; solving stroke.

Relevance of Cognition and Emotion for Patient-Reported Quality of Life After Stroke in Working Age: An Observational Cohort Study

Daniela Pinter^1,2^*,

Simon Fandler-Höfler²,

Viktoria Fruhwirth^1,2,

Lisa Berger^1,2,

Gerhard Bachmaier³,

Susanna Horner²,

Sebastian Eppinger²,

Markus Kneihsl²,

Christian Enzinger^1,2,4 and

Thomas Gattringer^2,4

¹Department of Neurology, Research Unit for Neuronal Plasticity and Repair, Medical University of Graz, Graz, Austria
²Department of Neurology, Medical University of Graz, Graz, Austria
³Institute for Medical Informatics, Statistics and Documentation, Medical University of Graz, Graz, Austria
⁴Division of Neuroradiology, Department of Radiology, Vascular and Interventional Radiology, Medical University of Graz, Graz, Austria

Background: Patient-reported quality of life (QoL) may help to capture sequela of stroke more comprehensively. We aimed to investigate QoL in working age persons with ischemic stroke regarding impaired domains and identify factors associated with better QoL.

Methods: We invited persons with stroke aged 18–55 years to participate in this prospective observational study. We assessed QoL and self-rated health using the EuroQol 5 Dimension questionnaire (EQ-5D) during hospital stay (baseline) and at 3-months follow-up (FU). Additionally, the National Institute of Health Stroke Scale (NIHSS), modified Rankin Scale (mRS), cognition (Montreal Cognitive assessment, MOCA), emotion (Hospital Anxiety and Depression Scale), and return to work were evaluated. We used hierarchical regression to identify predictors of QoL (self-rated health and QoL Index score) at FU.

Results: We included 138 persons with stroke (mean age = 43.6 ± 10 years; 41% female; median admission NIHSS = 2), of whom 99 participated at FU. QoL Index and self-rated health were correlated with NIHSS, mRS, anxiety, and depression at both timepoints. Although 80% had favorable functional outcome at FU (mRS < 2), high proportions of these persons reported problems in the “Pain and/or Discomfort” (25.3%) and “Anxiety/Depression” (22.8%) dimensions. Only discharge NIHSS and baseline MOCA independently predicted self-rated health at FU. Female sex, higher discharge NIHSS, and higher baseline depression scores predicted worse QoL Index scores at FU.

Conclusions: Three months post-stroke, working age persons with stroke frequently reported problems in dimensions not assessed by the routinely used mRS. Despite correlations between clinical scales and QoL, patient-reported outcomes and screening for cognition and emotion ensure a more comprehensive assessment of post-stroke consequences relevant for QoL.

Introduction

Stroke at working age is on the rise, with ~10–15% of all ischemic strokes occurring in persons aged below 55 years (1, 2). These stroke survivors may live many years with detrimental effects in multiple health domains, such as physical, psychological, and/or social problems (3).

Some so-called “hidden” consequences of stroke (e.g., cognitive impairment, anxiety, depression) are not captured by routine clinical scales like the modified Rankin Scale (mRS) (4–6). Therefore, assessment of patient-reported outcome measures are increasingly recommended (7) to better capture diverse sequelae of stroke (5, 8).

To date, few studies have examined health-related quality of life (QoL) in working age persons with stroke (9, 10). Identification of factors influencing QoL in this patient group is essential to guide comprehensive clinical assessment and rehabilitation decisions and enable a more efficient and patient orientated (post-stroke) health care.

Prior studies highlighted physical impairment and psychological factors, such as depression, anxiety or fatigue to be associated with QoL in working age persons with stroke (11, 12). Recent work showed that in older persons with stroke, depression and cognitive impairment are independent predictors of participation and independence (13).

In this prospective, observational, and single-center analysis, we aimed to (1) assess patient-reported QoL and associated factors in working age persons with acute ischemic stroke and (2) identify potential predictors of QoL at 3 months post-stroke.