Background and Purpose— Little is known about sex differences in stroke recovery The few available studies have found that female stroke survivors are less likely to achieve independence in activities of daily living and have poorer quality of life than male survivors Methods— A total of 373 acute stroke survivors discharged from 9 hospitals participating in a statewide stroke registry were prospectively enrolled in an outcomes study Follow-up data, including the Barthel Index and Stroke-Specific Quality of Life, were obtained from the survivor or a proxy by telephone interview 90 days postdischarge The independent effects of sex on activities of daily living independence (Barthel Index ≥95) and Stroke-Specific Quality of Life scores, controlling for age, race, subtype, prestroke ambulatory status, and other patient characteristics, were determined using adjusted odds ratios and least-squares means, respectively Results— Twenty-five percent of the patients required a proxy respondent In adjusted models, females were less likely to achieve activities of daily living independence (adjusted OR: 037, 95% CI: 019 to 087) Females had lower least-squares means Stroke-Specific Quality of Life scores in Physical Function (39 versus 42, P =002), Thinking (28 versus 34, P P =003), and Energy (26 versus 30, P Conclusions— Compared with males, female stroke survivors had lower functional recovery and poorer quality of life 3 months postdischarge These differences were not explained by females’ greater age at stroke onset or other demographic or clinical characteristics

Sex Differences in Stroke Recovery and Stroke-Specific Quality of Life Results From a Statewide Stroke Registry

As stroke care has developed, there has been a need to robustly assess the efficacy of interventions both at the level of the individual stroke survivor and in the context of clinical trials. To describe stroke-survivor recovery meaningfully, more sophisticated measures are required than simple dichotomous end points, such as mortality or stroke recurrence. As stroke is an exemplar disabling long-term condition, measures of function are well suited as outcome assessment. In this review, we will describe functional assessment scales in stroke, concentrating on three of the more commonly used tools: the National Institutes of Health Stroke Scale, the modified Rankin Scale, and the Barthel Index. We will discuss the strengths, limitations, and application of these scales and use the scales to highlight important properties that are relevant to all assessment tools. We will frame much of this discussion in the context of "clinimetric" analysis. As they are increasingly used to inform stroke-survivor assessments, we will also discuss some of the commonly used quality-of-life measures. A recurring theme when considering functional assessment is that no tool suits all situations. Clinicians and researchers should chose their assessment tool based on the question of interest and the evidence base around clinimetric properties.

/pdf/assessment-scales-in-stroke-clinimetric-and-clinical-1263s7gq05.pdf

Assessment scales in stroke: clinimetric and clinical considerations

Background: Understanding the determinants of quality of life (QoL) in amyotrophic lateral sclerosis (ALS) has become increasingly important with the recent emphasis on the comprehensive management of patients. 

Objective: To evaluate the determinants of QoL in ALS using two scales with different theoretical constructs: the Schedule for the Evaluation of QoL-Direct Weighting (SEIQoL-DW), which evaluates subjective aspects of QoL, and the McGill QoL Questionnaire (MQOL), which evaluates both health related and non-health related factors of QoL. 

Methods: Eighty consecutive patients with ALS underwent a battery of tests evaluating QoL and a series of physical, emotional, psychological, and socioeconomic predictor variables. A stepwise linear regression model was used to compare QoL scores and explicatory variables. 

Results: SEIQoL-DW score was related to social support, depression, religiosity, and socioeconomic status. Total MQOL score was related to social support, socioeconomic status, and clinical status. MQOL single item score (MQOL-SIS) was related to social support, depression, social withdrawal, and socioeconomic status. SEIQoL-DW score was not related to total MQOL score. Conversely, a significant correlation was found between SEIQoL-DW and MQOL-SIS. 

Conclusions: With both QoL scales, the most important explicatory variable of QoL was the self perceived quality of social support. Physical status was not relevant in determining QoL. This study indicates that health related QoL measures are not adequate to assess QoL in patients with ALS, because their appreciation of QoL mainly relies on psychological, supportive, and spiritual factors. Therapeutic interventions should consider the psychological needs of patients and pay greater attention to caregivers' issues.

https://jnnp.bmj.com/content/jnnp/75/11/1597.full.pdf

A cross sectional study on determinants of quality of life in ALS

Background and Purpose— Assessing poststroke depression may be complicated by aphasia, other cognitive deficits, and several somatic stroke-related symptoms. We studied the possible differences in performance of some commonly used instruments in screening depression after stroke. Methods— We compared the Beck Depression Inventory, Hamilton Rating Scale for Depression, Visual Analogue Mood Scale, proxy assessment, and Clinical Global Impression of the nursing and study personnel, together with Diagnostic and Statistical Manual of Mental Disorders, 3rd Edition, Revised diagnosis, in assessing depression after stroke in a follow-up study of 100 patients. The patients were studied at 2 weeks and at 2, 6, 12, and 18 months after stroke. Results— The feasibility rates of all assessment instruments studied were fairly similar, but the prevalence rates differed according to the assessment instruments, varying from the lowest rates with a Diagnostic and Statistical Manual of Mental Disorders, 3rd Edition, Revised-...

Assessment of depression after stroke: a comparison of different screening instruments.

This is the first report that inhibition of negative regulators of skeletal muscle by a soluble form of activin type IIB receptor (ACE-031) increases muscle mass independent of fiber-type expression. This finding is distinct from the effects of selective pharmacological inhibition of myostatin (GDF-8), which predominantly targets type II fibers. In our study 8-wk-old C57BL/6 mice were treated with ACE-031 or vehicle control for 28 days. By the end of treatment, mean body weight of the ACE-031 group was 16% greater than that of the control group, and wet weights of soleus, plantaris, gastrocnemius, and extensor digitorum longus muscles increased by 33, 44, 46 and 26%, respectively (P<0.05). Soleus fiber-type distribution was unchanged with ACE-031 administration, and mean fiber cross-sectional area increased by 22 and 28% (P<0.05) in type I and II fibers, respectively. In the plantaris, a predominantly type II fiber muscle, mean fiber cross-sectional area increased by 57% with ACE-031 treatment. Analysis of myosin heavy chain (MHC) isoform transcripts by real-time PCR indicated no change in transcript levels in the soleus, but a decline in MHC I and IIa in the plantaris. In contrast, electrophoretic separation of total soleus and plantaris protein indicated that there was no change in the proportion of MHC isoforms in either muscle. Thus these data provide optimism that ACE-031 may be a viable therapeutic in the treatment of musculoskeletal diseases. Future studies should be undertaken to confirm that the observed effects are not age dependent or due to the relatively short study duration.

https://www.physiology.org/doi/pdf/10.1152/japplphysiol.00866.2009

Gwendoline M Kiebert

Papers

Patients' health-related quality of life and utilities associated with different stages of amyotrophic lateral sclerosis.