Repeated measures of modified Rankin Scale scores to assess functional recovery from stroke: AFFINITY study findings

Alexander Chye; Maree L. Hackett; Graeme J. Hankey; Erik Lundström; Osvaldo P. Almeida; John Gommans; Martin Dennis; Stephen Jan; Gillian E. Mead; Andrew H. Ford; Christopher Etherton Beer; Leon Flicker; Candice Delcourt; Laurent Billot; Craig S. Anderson; Katharina Stibrant Sunnerhagen; Qilong Yi; Severine Bompoint; Thang Huy Nguyen; Thomas Lung

doi:10.1161/jaha.121.025425

Repeated measures of modified Rankin Scale scores to assess functional recovery from stroke: AFFINITY study findings

Alexander Chye, Maree L. Hackett, Graeme J. Hankey, Erik Lundström, Osvaldo P. Almeida, John Gommans, Martin Dennis, Stephen Jan, Gillian E. Mead, Andrew H. Ford, Christopher Etherton Beer, Leon Flicker, Candice Delcourt, Laurent Billot, Craig S. Anderson, Katharina Stibrant Sunnerhagen, Qilong Yi, Severine Bompoint, Thang Huy Nguyen, Thomas Lung

Macquarie Medical School

Research output: Contribution to journal › Article › peer-review

26 Citations (Scopus)

21 Downloads (Pure)

Abstract

Background: Function after acute stroke using the modified Rankin Scale (mRS) is usually assessed at a point in time. The analytical implications of serial mRS measurements to evaluate functional recovery over time is not completely understood. We compare repeated‐measures and single‐measure analyses of the mRS from a randomized clinical trial.

Methods and Results: Serial mRS data from AFFINITY (Assessment of Fluoxetine in Stroke Recovery), a double‐blind placebo randomized clinical trial of fluoxetine following stroke (n=1280) were analyzed to identify demographic and clinical associations with functional recovery (reduction in mRS) over 12 months. Associations were identified using single‐measure (day 365) and repeated‐measures (days 28, 90, 180, and 365) partial proportional odds logistic regression. Ninety‐five percent of participants experienced a reduction in mRS after 12 months. Functional recovery was associated with age at stroke <70 years; no prestroke history of diabetes, coronary heart disease, or ischemic stroke; prestroke history of depression, a relationship partner, living with others, independence, or paid employment; no fluoxetine intervention; ischemic stroke (compared with hemorrhagic); stroke treatment in Vietnam (compared with Australia or New Zealand); longer time since current stroke; and lower baseline National Institutes of Health Stroke Scale & Patient Health Questionnaire‐9 scores. Direction of associations was largely concordant between single‐measure and repeated‐measures models. Association strength and variance was generally smaller in the repeated‐measures model compared with the single‐measure model.

Conclusions: Repeated‐measures may improve trial precision in identifying trial associations and effects. Further repeated‐measures stroke analyses are required to prove methodological value.

Registration: URL: http://www.anzctr.org.au; Unique identifier: ACTRN12611000774921.

Original language	English
Article number	e025425
Pages (from-to)	1-11
Number of pages	23
Journal	Journal of the American Heart Association
Volume	11
Issue number	16
DOIs	https://doi.org/10.1161/jaha.121.025425
Publication status	Published - 5 Aug 2022

Bibliographical note

Copyright the Author(s) 2022. Version archived for private and non-commercial use with the permission of the author/s and according to publisher conditions. For further rights please contact the publisher.

Keywords

cerebrovascular disease
functional outcomes
modified Rankin Scale
partial proportional odds
repeated measures
stroke

Access to Document

10.1161/jaha.121.025425Licence: CC BY-NC-ND

Publisher version (open access)Final published version, 872 KBLicence: CC BY-NC-ND

Cite this

Chye, A., Hackett, M. L., Hankey, G. J., Lundström, E., Almeida, O. P., Gommans, J., Dennis, M., Jan, S., Mead, G. E., Ford, A. H., Etherton Beer, C., Flicker, L., Delcourt, C., Billot, L., Anderson, C. S., Sunnerhagen, K. S., Yi, Q., Bompoint, S., Nguyen, T. H., & Lung, T. (2022). Repeated measures of modified Rankin Scale scores to assess functional recovery from stroke: AFFINITY study findings. Journal of the American Heart Association, 11(16), 1-11. Article e025425. https://doi.org/10.1161/jaha.121.025425

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title = "Repeated measures of modified Rankin Scale scores to assess functional recovery from stroke: AFFINITY study findings",

abstract = "Background: Function after acute stroke using the modified Rankin Scale (mRS) is usually assessed at a point in time. The analytical implications of serial mRS measurements to evaluate functional recovery over time is not completely understood. We compare repeated‐measures and single‐measure analyses of the mRS from a randomized clinical trial. Methods and Results: Serial mRS data from AFFINITY (Assessment of Fluoxetine in Stroke Recovery), a double‐blind placebo randomized clinical trial of fluoxetine following stroke (n=1280) were analyzed to identify demographic and clinical associations with functional recovery (reduction in mRS) over 12 months. Associations were identified using single‐measure (day 365) and repeated‐measures (days 28, 90, 180, and 365) partial proportional odds logistic regression. Ninety‐five percent of participants experienced a reduction in mRS after 12 months. Functional recovery was associated with age at stroke <70 years; no prestroke history of diabetes, coronary heart disease, or ischemic stroke; prestroke history of depression, a relationship partner, living with others, independence, or paid employment; no fluoxetine intervention; ischemic stroke (compared with hemorrhagic); stroke treatment in Vietnam (compared with Australia or New Zealand); longer time since current stroke; and lower baseline National Institutes of Health Stroke Scale \& Patient Health Questionnaire‐9 scores. Direction of associations was largely concordant between single‐measure and repeated‐measures models. Association strength and variance was generally smaller in the repeated‐measures model compared with the single‐measure model. Conclusions: Repeated‐measures may improve trial precision in identifying trial associations and effects. Further repeated‐measures stroke analyses are required to prove methodological value. Registration: URL: http://www.anzctr.org.au; Unique identifier: ACTRN12611000774921.",

keywords = "cerebrovascular disease, functional outcomes, modified Rankin Scale, partial proportional odds, repeated measures, stroke",

author = "Alexander Chye and Hackett, \{Maree L.\} and Hankey, \{Graeme J.\} and Erik Lundstr{\"o}m and Almeida, \{Osvaldo P.\} and John Gommans and Martin Dennis and Stephen Jan and Mead, \{Gillian E.\} and Ford, \{Andrew H.\} and \{Etherton Beer\}, Christopher and Leon Flicker and Candice Delcourt and Laurent Billot and Anderson, \{Craig S.\} and Sunnerhagen, \{Katharina Stibrant\} and Qilong Yi and Severine Bompoint and Nguyen, \{Thang Huy\} and Thomas Lung",

note = "Copyright the Author(s) 2022. Version archived for private and non-commercial use with the permission of the author/s and according to publisher conditions. For further rights please contact the publisher.",

year = "2022",

month = aug,

day = "5",

doi = "10.1161/jaha.121.025425",

language = "English",

volume = "11",

pages = "1--11",

journal = "Journal of the American Heart Association",

issn = "2047-9980",

publisher = "Wiley-Blackwell, Wiley",

number = "16",

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Chye, A, Hackett, ML, Hankey, GJ, Lundström, E, Almeida, OP, Gommans, J, Dennis, M, Jan, S, Mead, GE, Ford, AH, Etherton Beer, C, Flicker, L, Delcourt, C, Billot, L, Anderson, CS, Sunnerhagen, KS, Yi, Q, Bompoint, S, Nguyen, TH & Lung, T 2022, 'Repeated measures of modified Rankin Scale scores to assess functional recovery from stroke: AFFINITY study findings', Journal of the American Heart Association, vol. 11, no. 16, e025425, pp. 1-11. https://doi.org/10.1161/jaha.121.025425

TY - JOUR

T1 - Repeated measures of modified Rankin Scale scores to assess functional recovery from stroke

T2 - AFFINITY study findings

AU - Chye, Alexander

AU - Hackett, Maree L.

AU - Hankey, Graeme J.

AU - Lundström, Erik

AU - Almeida, Osvaldo P.

AU - Gommans, John

AU - Dennis, Martin

AU - Jan, Stephen

AU - Mead, Gillian E.

AU - Ford, Andrew H.

AU - Etherton Beer, Christopher

AU - Flicker, Leon

AU - Delcourt, Candice

AU - Billot, Laurent

AU - Anderson, Craig S.

AU - Sunnerhagen, Katharina Stibrant

AU - Yi, Qilong

AU - Bompoint, Severine

AU - Nguyen, Thang Huy

AU - Lung, Thomas

N1 - Copyright the Author(s) 2022. Version archived for private and non-commercial use with the permission of the author/s and according to publisher conditions. For further rights please contact the publisher.

PY - 2022/8/5

Y1 - 2022/8/5

N2 - Background: Function after acute stroke using the modified Rankin Scale (mRS) is usually assessed at a point in time. The analytical implications of serial mRS measurements to evaluate functional recovery over time is not completely understood. We compare repeated‐measures and single‐measure analyses of the mRS from a randomized clinical trial. Methods and Results: Serial mRS data from AFFINITY (Assessment of Fluoxetine in Stroke Recovery), a double‐blind placebo randomized clinical trial of fluoxetine following stroke (n=1280) were analyzed to identify demographic and clinical associations with functional recovery (reduction in mRS) over 12 months. Associations were identified using single‐measure (day 365) and repeated‐measures (days 28, 90, 180, and 365) partial proportional odds logistic regression. Ninety‐five percent of participants experienced a reduction in mRS after 12 months. Functional recovery was associated with age at stroke <70 years; no prestroke history of diabetes, coronary heart disease, or ischemic stroke; prestroke history of depression, a relationship partner, living with others, independence, or paid employment; no fluoxetine intervention; ischemic stroke (compared with hemorrhagic); stroke treatment in Vietnam (compared with Australia or New Zealand); longer time since current stroke; and lower baseline National Institutes of Health Stroke Scale & Patient Health Questionnaire‐9 scores. Direction of associations was largely concordant between single‐measure and repeated‐measures models. Association strength and variance was generally smaller in the repeated‐measures model compared with the single‐measure model. Conclusions: Repeated‐measures may improve trial precision in identifying trial associations and effects. Further repeated‐measures stroke analyses are required to prove methodological value. Registration: URL: http://www.anzctr.org.au; Unique identifier: ACTRN12611000774921.

AB - Background: Function after acute stroke using the modified Rankin Scale (mRS) is usually assessed at a point in time. The analytical implications of serial mRS measurements to evaluate functional recovery over time is not completely understood. We compare repeated‐measures and single‐measure analyses of the mRS from a randomized clinical trial. Methods and Results: Serial mRS data from AFFINITY (Assessment of Fluoxetine in Stroke Recovery), a double‐blind placebo randomized clinical trial of fluoxetine following stroke (n=1280) were analyzed to identify demographic and clinical associations with functional recovery (reduction in mRS) over 12 months. Associations were identified using single‐measure (day 365) and repeated‐measures (days 28, 90, 180, and 365) partial proportional odds logistic regression. Ninety‐five percent of participants experienced a reduction in mRS after 12 months. Functional recovery was associated with age at stroke <70 years; no prestroke history of diabetes, coronary heart disease, or ischemic stroke; prestroke history of depression, a relationship partner, living with others, independence, or paid employment; no fluoxetine intervention; ischemic stroke (compared with hemorrhagic); stroke treatment in Vietnam (compared with Australia or New Zealand); longer time since current stroke; and lower baseline National Institutes of Health Stroke Scale & Patient Health Questionnaire‐9 scores. Direction of associations was largely concordant between single‐measure and repeated‐measures models. Association strength and variance was generally smaller in the repeated‐measures model compared with the single‐measure model. Conclusions: Repeated‐measures may improve trial precision in identifying trial associations and effects. Further repeated‐measures stroke analyses are required to prove methodological value. Registration: URL: http://www.anzctr.org.au; Unique identifier: ACTRN12611000774921.

KW - cerebrovascular disease

KW - functional outcomes

KW - modified Rankin Scale

KW - partial proportional odds

KW - repeated measures

KW - stroke

UR - https://www.scopus.com/pages/publications/85136155537

U2 - 10.1161/jaha.121.025425

DO - 10.1161/jaha.121.025425

M3 - Article

C2 - 35929466

SN - 2047-9980

VL - 11

SP - 1

EP - 11

JO - Journal of the American Heart Association

JF - Journal of the American Heart Association

IS - 16

M1 - e025425

ER -