Original article
The Impact of Mild Stroke on Meaningful Activity and Life Satisfaction

https://doi.org/10.1016/j.jstrokecerebrovasdis.2006.04.001Get rights and content

Patients with mild stroke are assumed to achieve full recovery with little or no intervention. However, recent studies suggest that such patients may experience persistent disability and difficulty with complex activities. We prospectively assessed the impact of mild stroke (National Institutes of Health Stroke Scale [NIHSS] score ≤ 5) with standard assessments of function, health-related well-being, activity participation, and stroke-specific quality of life. Of 771 patients admitted over 12 months, 377 had an NIHSS score of ≤ 5; of these, 244 met additional inclusion criteria, and 219 were assessed 6 months after stroke onset. Despite full independence in basic activities of daily living, many patients (87%) reported residual stroke-related changes. On average, 7 (standard deviation [SD] = 6.21) stroke-related problems (SD = 6.21) were reported on the Stroke-Adapted Sickness Impact Profile (SA-SIP). Changes in work, driving, and recreational activities were reported. Motor impairment as measured by the NIHSS or the Functional Independence Measure (FIM) motor subscale did not influence scores on outcome measures. Regression analysis predicting life satisfaction (R2 = .62) was computed. Our results indicated that SA-SIP score, emotional well-being, and activity participation were significant, but age, race, sex, NIHSS score, and FIM motor and cognitive scores were not significant. In our sample, the determinants of life satisfaction after mild stroke differed from those reported after more severe stroke. Given the mild motor impairments in our sample, other, more subtle consequences of stroke, such as depression, impaired executive function or attention, or other neurologic impairments, may play more important roles in life satisfaction.

Section snippets

Subjects

Study participants were recruited through the Cognitive Rehabilitation Research Group (CRRG) of Washington University. The CRRG registers participants from the Acute Neurology Stroke Service of the Barnes-Jewish Hospital. An NIHSS-certified nurse coordinator prospectively evaluates and records clinical and demographic information for all patients. All patients admitted between May 2001 and April 2002 (n = 884) were candidates for this study. Complete data were available for 771 patients with

NIHSS10

The NIHSS assesses neurologic impairment as an indicator of stroke severity. This 13-item test produces scores ranging from 0 (no deficit) to 46 (severe deficit).

Functional Independence Measure (FIM)11

The telephone version of the FIM uses 18 items to grade the level of cognitive and physical assistance necessary for function. Item scores range from 1 (completely dependent) to 7 (completely independent). Two summary scores (Mobility/Self-Care and Communication/Cognition) are derived. The maximum total scores are 91 and 35, respectively; higher scores represent greater independence.

Stroke-Adapted Sickness Impact Profile (SA-SIP)12

The SA-SIP contains 30 true/false statements assessing stroke-related symptoms. Eight domains are assessed. The total score represents the number of problems reported. The maximum total score is 30.

Reintegration to Normal Living (RNL) Scale13

The RNL assesses satisfaction with ADL, home and community mobility, social roles and responsibilities, and productive pursuits (eg, work, school, volunteer activities) as indicators of quality of life. Items are scored on Likert scale of 1 (totally dissatisfied) to 5 (totally satisfied). The maximum total score is 55; higher scores are indicative of more positive life satisfaction.

Short Form 12 Health Survey (SF-12)14,15

The SF-12 is a 12-item abbreviation of the Medical Outcomes Study (MOS) 36-item instrument. It assesses a broad range of categories influenced by health problems: physical and social function, mental and physical state, and perceptions of well-being and personal health. Two subscale scores are obtained, a Physical Health Score (PHS) and a Mental Health Score (MHS). Higher scores indicate better HRQOL. The MHS is used as an indicator of depression in this study.

Activity Card Sort (ACS) Interview16,17

The ACS assesses participation in 55 instrumental, social, and high- and low-demand physical leisure activities. For each activity, the participant is asked to use the following descriptors: never done, given up due to stroke, doing less often due to stroke, and doing now. The current activity level score is the percentage of prestroke activities in which a person is currently involved. This score is obtained by dividing the sum total of current activities by the sum total of previous

Results

Table 1 describes sociodemographic characteristics, total NIHSS scores, and discharge dispositions of the patients in the sample. The participants were predominantly female (57%) and Caucasian (58%). A total of 35% of the patients were discharged to home with no postacute rehabilitation services.

Most participants scored 0 or 1 on all NIHSS items. Only 12% had a score of 2 on any single item. The most common impairments were facial weakness, dysarthria, and sensory loss. Upper extremity

Discussion

We examined the impact of mild stroke on meaningful activities and life satisfaction; by using a criterion of NIHSS scores of ≤ 5, we studied a population more mildly affected than that evaluated in most other published studies. Our results suggest that the current notion of full or almost full recovery after even the mildest of strokes6, 19 may not apply to a substantial proportion of patients.

Many patients in our sample reported persistent stroke-related symptoms that adversely affected their

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