Background: The modified Rankin Scale (mRS) and the Barthel Index (BI) are both commonly employed measures of recovery used in intracerebral hemorrhage (ICH) patients. While these measures have been utilized routinely between 3 to 6 months post-hemorrhage, few outcome studies have compared improvements in these measures in long-term outcome.out to one year. The aim of this study was to examine differences in improvement across these measures through up to 12 months post-ICH.
Methods: 139 patients diagnosed with primary ICH at Yale-New Haven Hospital were prospectively enrolled in this observational study between July 1, 2014, and July 1, 2016. Patient recovery was evaluated using the mRS and BI at discharge, 3 months, 6 months, and 12 months. Repeated-measures parametric and non-parametric testing was conducted to examine improvement in measures over time.
Results: Using the BI, there was a significant improvement across time points (p = 0.005), with follow-up testing showing improvement between discharge and 3 months (p < 0.001), 6 months (p < 0.001), and 12 months (p = 0.036), and between 3 months and 12 months (p = 0.021). There was no significant trend in mRS scores across all time points in non-parametric testing (p > 0.05). Between individual time points, there was a significant improvement in mRS scores between discharge and 3 months (p = 0.004) as well as 6 months (p = 0.010).
Conclusions: These results suggest improved recovery of ICH patients in activities of daily living up to 1 year post-hemorrhage. While the mRS has a plateau effect in measuring recovery for this patient population between 3 and 6 months, the BI may be a more sensitive measure for assessing recovery up to 12 months.