Stroke impairment categories: A new way to classify the effects of stroke based on stroke-related impairments

Matthew Gittins, David Lugo-Palacios, Andy Vail, Audrey Bowen, Lizz Paley, Benjamin Bray, Sarah Tyson*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

1 Citation (Scopus)

Abstract

Objective: To create a classification system based on stroke-related impairments. Data source: All adults with stroke admitted for at least 72 hours in England, Wales and Northern Ireland from July 2013 to July 2015 extracted from the Sentinel Stroke National Audit Programme Analysis: Impairments were defined using the National Institute of Health Stroke Scale scores at admission. Common combinations of impairments were identified based on geometric coding and expert knowledge. Validity of the classification was assessed using standard descriptive statistics to report and compare patients’ characteristics, therapy received and outcomes in each group. Results: Data from 94,905 patients were extracted. The items of the National Institute of Health Stroke Scale (on admission) were initially grouped into four body systems: Cognitive, Motor, Sensory and Consciousness. Seven common combinations of these impairments were identified (in order of stroke severity); Patients with Loss of Consciousness (n = 6034, 6.4%); those with Motor + Cognitive + Sensory impairments (n = 28,226, 29.7%); Motor + Cognitive impairments (n = 16,967, 17.9%); Motor + Sensory impairments (n = 9882, 10.4%); Motor Only impairments (n = 20,471, 21.6%); Any Non-Motor impairments (n = 7498, 7.9%); and No Impairments (n = 5827, 6.1%). There was a gradation of age, premorbid disability, mortality and disability on discharge. People with the most and least severe categories were least likely to receive therapy, and received least therapy (−20 minutes/day of stay) compared to −35 minutes/day of stay for the moderately severe categories. Conclusions: A classification system of seven Stroke Impairment Categories has been presented.

Original languageEnglish
Pages (from-to)446-458
Number of pages13
JournalClinical Rehabilitation
Volume35
Issue number3
DOIs
Publication statusPublished - Mar 2021
Externally publishedYes

Bibliographical note

Funding Information:
The authors acknowledge and thank Prof Martin James, Ms Alex Hoffman and the Intercollegiate Stroke Working Party of the Sentinel Stroke National Audit Programme for their invaluable discussion and insights regarding interpretation of the results. The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This work was funded by the National Institute for Health Research (NIHR) under its Health Service and Development Research Programme (Grant Reference 14/198/09). The views expressed are those of the authors and not necessarily those of the NHS, NIHR or the Department of Health and Social Care.

Funding Information:
The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This work was funded by the National Institute for Health Research (NIHR) under its Health Service and Development Research Programme (Grant Reference 14/198/09). The views expressed are those of the authors and not necessarily those of the NHS, NIHR or the Department of Health and Social Care.

Publisher Copyright:
© The Author(s) 2020.

Keywords

  • Stroke
  • disability
  • length of stay
  • occupational therapy
  • physiotherapy
  • psychology
  • rehabilitation
  • speech and language therapy

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