Original articleThe Impact of Mild Stroke on Meaningful Activity and 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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Supported by the James S. McDonnell Foundation (grant 9832CRHQUA11).