Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London.
Stoke Mandeville Hospital, Buckinghamshire NHS Trust, UK.
J Stroke Cerebrovasc Dis. 2024 Dec;33(12):108023. doi: 10.1016/j.jstrokecerebrovasdis.2024.108023. Epub 2024 Sep 19.
Post-stroke morbidity is common, but little is known about the burden on patients' lives from their own perspective. Understanding morbidity from the point of view of the patient may support targeted intervention in post-stroke recovery. This study used a stroke specific Patient Reported Outcome Measure (PROM) containing Mental health (MH) and Physical Health (PH) domains and 5 stroke specific questions. We aimed to consider trends over a 6-month period and further assess the association between the MH and PH measures and common clinical measures.
A multicenter prospective cohort study was conducted at 19 hospital sites across England and Wales. Patients were enrolled from August 2018 to September 2019. Clinical measures and PROMs were assessed at three timepoints: acutely following the index stroke, at 3 and 6-months post-stroke. Clinical measures and PROMs were assessed in each of these points.
Physical health PROM domains show significant gradual improvement across the study period (χ 42.6312, p<0.0001), whereas cognitive function domains (χ 3.7849, p<0.875) did not echo this trend. All clinical measures (GAD-7, PHQ9, MoCA, MRS) were associated with poorer PROM MH outcomes, (aMD -4.4, CI -0.59, -0.29, p≤0.001, aMD -0.45, CI -0.59, -0.32, p=<0.001, aMD 0.75, CI 0.56, 0.95, aMD -1.91, CI -2.41, -1.47, p≤0.001). Clinical measures of disability, as per the MRS, are associated with poor PROM PH scores (aMD -0.57, 95% CI -0.94, -0.20, p=0.003).
This research indicates there is unmet cognitive burden in stroke survivors. PROMs may be able to measure unmet more discretely than common clinical tools that are used post-stroke. Further research and guidance on how to integrate PROMs into current clinical frameworks is essential.
中风后的发病率较高，但从患者自身角度了解发病率对患者生活的影响还知之甚少。从患者的角度了解发病率可能有助于针对中风后的恢复进行有针对性的干预。本研究使用了一种特定于中风的患者报告结局测量（PROM），其中包含心理健康（MH）和身体健康（PH）两个领域以及 5 个中风相关问题。我们旨在考虑 6 个月期间的趋势，并进一步评估 MH 和 PH 测量值与常见临床测量值之间的相关性。
这是一项在英格兰和威尔士的 19 家医院进行的多中心前瞻性队列研究。2018 年 8 月至 2019 年 9 月期间，招募了患者。在三个时间点评估了临床测量值和 PROMs：中风后急性期、中风后 3 个月和 6 个月。在这些时间点都评估了临床测量值和 PROMs。
身体健康 PROM 领域在整个研究期间显示出显著的逐渐改善（χ 42.6312，p<0.0001），而认知功能领域（χ 3.7849，p<0.875）则没有反映出这种趋势。所有临床测量值（GAD-7、PHQ9、MoCA、MRS）均与较差的 PROM MH 结果相关（aMD -4.4，CI -0.59，-0.29，p≤0.001，aMD -0.45，CI -0.59，-0.32，p=<0.001，aMD 0.75，CI 0.56，0.95，aMD -1.91，CI -2.41，-1.47，p≤0.001）。MRS 评估的残疾临床测量值与较差的 PROM PH 评分相关（aMD -0.57，95% CI -0.94，-0.20，p=0.003）。
这项研究表明，中风幸存者存在未满足的认知负担。与中风后常用的临床工具相比，PROM 可能能够更准确地测量未满足的需求。进一步研究和指导如何将 PROM 纳入当前的临床框架至关重要。
