Repeated Measures of Modified Rankin Scale Scores to Assess Functional Recovery From Stroke: AFFINITY Study Findings

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

Research output: Contribution to journalArticlepeer-review

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 repeatedmeasures stroke analyses are required to prove methodological value. REGISTRATION: URL: http://www.anzctr.org.au; Unique identifier: ACTRN12611000774921.

Original languageEnglish
Article numbere025425
JournalJournal of the American Heart Association
Volume11
Issue number16
Early online date5 Aug 2022
DOIs
Publication statusPublished - 16 Aug 2022

Keywords

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

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