Disability and Patient Perceived Outcomes in Stroke

Kwon S, Hartzema AG, Duncan PW, Kimberlin C, Ried LD, Yarandi HN. Disability and Patient Perceived Outcomes in Stroke. Paper presented at: University of Florida College of Public Health and Health Professions Annual Research Day; 2004 Apr 15; Gainesville, FL.

Background and Purpose: Stroke typically impacts patients in one of two ways; mortality, or disability. Even though both disability and mortality produce significant burden for patients and society, disability outcomes have not been evaluated well compared to mortality outcomes in the literature. More attention needs to be given to long term outcomes of stroke survivors and disability. Objectives: 1.) To present a method to operationalize the evaluation of the stroke preventive intervention effectiveness in terms of residual disability in stroke survivors.2.) To evaluate the effects of ACE inhibitor recurrent stroke preventive intervention on long term disability. Methods: Two datasets were used in this study: PROGRESS, a four year follow-up multinational clinical trial tested the effectiveness of recurrent stroke preventive intervention using an ACE inhibitor vs. placebo, and Kansas City Stroke Study data, a six month follow-up cohort study examined the post-stroke disability trajectory, used to facilitate the operationalization of disability evaluation procedure. Statistical Analysis: Descriptive summary statistics to describe dataInferential statistics such as logistic regression, non-parametric ANOVA, chi-square test, t-testResults:Four disability levels were identified.1C-BI1 ? 0 < = BI < 15; C-BI3 ? 15 < = BI < 70; C-BI4 ? 70 < = BI < 95; C-BI5 ? 95 < = BI < = 100Utility Estimates: C-BI1 = 9[10,7.5], C-BI3 = 8[10,5], C-BI4 = 7[9,2.5]; C-BI5 = 1[5,0.083]Mortality difference: 0.4% absolute.Morbidity (disability) difference: statistically significant after Yr2, but difficult to identify the clinical meaning of score differences. Morbidity (disability) difference after categorization: statistically significant differences were identified after Yr3. Mortality and morbidity (disability) in active and placebo treatment groups are illustrated in the above graph. Graph left: truncated at 4yr point. Graph right: prediction is provided based on the transition probability from the four year treatment effectiveness. Natural death was not considered.There was a slight difference in utility outcomes per person in active and placebo group. By the end of the 10 yr evaluation window, approx 0.12 difference in utility between active and placebo treatment groups was predicted. Conclusion and Discussion:This work conceptualized and operationalized how to evaluate the residual disability in stroke outcomes evaluation, which has not been well evaluated in the literature. The active treatment group shows significantly better outcomes in terms of disability and patient outcomes, but the difference between the two groups was not large. It is possible that the instrument used in this study may not be sensitive enough to accurately evaluate disability outcome. Further research is strongly recommended to evaluate the effects of ACE-inhibitors on long term stroke disability.