“Good outcome” after stroke isn’t enough

Problems with mood and the ability to carry out tasks after a stroke are just as common and disabling, even after years of therapy, in those who are considered the “best possible outcome” patients, as they are with patients deemed to have more severe functional impairments, suggests a new study.

“It was surprising that so many people with the best possible results after a stroke continue to have limitations in how they’ve gotten back to their lives, and have symptoms of mood or cognitive impairment even after years of therapy and recovery time,” says Dr. Rick Swartz, senior author of the study published in the journal Stroke, and medical director of the North & East GTA Regional Stroke Program at Sunnybrook.

“It is often not the motor deficits from stroke that cause the greatest barriers for my patients – they can often compensate well for problems with weakness for example. Rather, their ability to return to high-demand work or home lives can be impacted by other effects from the stroke such as depression and anxiety, fatigue and sleep problems, and/or cognitive impairment.”

The study researchers looked past the typical 90-day or one-year mark after a stroke to see how people were doing two to three years post-stroke.

“We incorporated broader concepts of function into our assessments, such as re-integration back to normal activities and symptoms of mood or cognitive impairment, rather than simply independence in motor or self-care tasks (which is what current clinical assessments after stroke focus on),” says Arunima Kapoor, lead author of the paper and a research assistant in the Division of Neurology at Sunnybrook.

“These issues are often under-identified, under-treated and under-researched in the stroke world, yet for some individuals they can be the main limiting factor impacting their quality of life,” adds Dr. Swartz, Kapoor’s supervisor and an assistant professor of Neurology at University of Toronto.

The researchers stress more research is needed to expand the scope of patient outcomes assessed – to include quality of life for example and to incorporate the preferences of families and individuals with lived experience – and to broaden investigations to more global assessments beyond the Modified Rankin Score assessed in this study.

“Greater attention to long-term functional, social and occupational outcomes after stroke are needed,” says Dr. Swartz. “We hope that this study will help to catalyze that work, so that interventions to improve these outcomes can be found.”