Background: Multiple domains of health are impacted in patients with ischemic stroke, which may vary by degree of disability. The objective of this study was to examine patient-reported health for 6 domains across levels of disability compared to the U.S. general population.
Methods: Observational cohort study of 811 ischemic stroke patients (937 visits) seen in a cerebrovascular clinic 2/17/15 - 8/8/16 who completed the routinely collected PROMIS patient-reported outcome measures (PROMs): Physical Function (PF), Satisfaction with Social Roles (SatSocRol), Fatigue, Anxiety, Sleep Disturbance, and Pain Interference. PROMIS scores are standardized to the U.S. population (mean score = 50). Providers completed the NIHSS and modified Rankin (mRS). Distribution of PROMIS scores were calculated across mRS levels. Multivariable regression was performed to evaluate the association of the following factors with PROM scores: age, sex, race, mRS, and time from stroke (0-90 d, 91-365 d, >365 d).
Results: Patients with no-minimal disability (mRS 0-1) had PROMIS scores that were similar to the general population. PROMIS scores increased at higher mRS levels, although correlation between scores and mRS level varied (Sleep ρ= 0.172 to PF ρ=0.483). Within each mRS level > 1, highest (worst) scores were in PF, SatSocRol, and Cognition domains (Graph). Female sex was associated with higher Fatigue (p=0.003), Anxiety (p<0.0001), PF (p=0.021), and Cognition (p=0.001) scores. Age was associated with higher PF (p<0.0001) and lower Anxiety (p=0.023) scores.
Conclusion: Patients with ischemic stroke reported symptoms in multiple health domains that increase to varying degrees at higher levels of disability. PF, SatSocRol, and Cognition were most impacted at all disability levels. This information improves our understanding of stroke’s impact on patients compared to the general population and brings attention to the importance of social roles and cognition to stroke survivors.