WSO - April 2024 - 442

1215660
WSO
International Journal of StrokeOzkan et al.
Research
Prevalence, patterns, and predictors
of patient-reported non-motor
outcomes at 30 days after acute stroke:
Prospective observational hospital
cohort study
Hatice Ozkan1,2 , Gareth Ambler3, Gargi Banerjee1,2,4
Simone Browning2, Alex P Leff1,2 , Nick S Ward1,2,
Robert J Simister1,2 and David J Werring1,2
Abstract
Background: Adverse non-motor outcomes are common after acute stroke and likely to substantially affect quality
of life, yet few studies have comprehensively assessed their prevalence, patterns, and predictors across multiple health
domains.
Aims: We aimed to identify the prevalence, patterns, and the factors associated with non-motor outcomes 30 days
after stroke.
Methods: This prospective observational hospital cohort study-Stroke Investigation in North and Central London
(SIGNAL)-identified patients with acute ischemic stroke or intracerebral hemorrhage (ICH) admitted to the Hyperacute
Stroke Unit (HASU) at University College Hospital (UCH), London, between August 1, 2018 and August 31, 2019.
We assessed non-motor outcomes (anxiety, depression, fatigue, sleep, participation in social roles and activities, pain,
bowel function, and bladder function) at 30-day follow-up using the Patient-Reported Outcome Measurement Information
System-Version 29 (PROMIS-29) scale and Barthel Index scale.
Results: We obtained follow-up data for 605/719 (84.1%) eligible patients (mean age 72.0 years; 48.3% female; 521 with
ischemic stroke, 84 with ICH). Anxiety (57.0%), fatigue (52.7%), bladder dysfunction (50.2%), reduced social participation
(49.2%), and pain (47.9%) were the commonest adverse non-motor outcomes. The rates of adverse non-motor
outcomes in ⩾ 1, ⩾ 2 and ⩾ 3 domains were 89%, 66.3%, and 45.8%, respectively; in adjusted analyses, stroke due to ICH
(compared to ischemic stroke) and admission stroke severity were the strongest and most consistent predictors. There
were significant correlations between bowel dysfunction and bladder dysfunction (κ = 0.908); reduced social participation
and bladder dysfunction (κ = 0.844); and anxiety and fatigue (κ = 0.613). We did not identify correlations for other
pairs of non-motor domains.
Conclusion: Adverse non-motor outcomes were very common at 30 days after stroke, affecting nearly 90% of evaluated
patients in at least one health domain, about two-thirds in two or more domains, and almost 50% in three or more
domains. Stroke due to ICH and admission stroke severity were the strongest and most consistent predictors. Adverse
outcomes occurred in pairs of domains, such as with anxiety and fatigue. Our findings emphasize the importance of a
multi-domain approach to effectively identify adverse non-motor outcomes after stroke to inform the development of
more holistic patient care pathways after stroke.
1UCL Queen Square Institute of Neurology, London, UK
2 Hyper Acute Stroke Unit, National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust,
London, UK
3Department of Statistical Science, University College London, London, UK
4MRC Prion Unit at UCL, Institute of Prion Diseases, London, UK
Corresponding author:
David Werring, Hyper Acute Stroke Unit, National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS
Foundation Trust, Queen Square, London, WC1N 3BG, UK.
Email: d.werring@ucl.ac.uk
International Journal of Stroke, 19(4)
,
International Journal of Stroke
2024, Vol. 19(4) 442 -451
© 2023 World Stroke Organization
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DOI: 10.1177/17474930231215660
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