Psychological disorders after stroke are an important influence on functional outcomes: a prospective cohort study.
OBJECTIVE
Psychological disorders are recognized as an important and common problem after stroke but little is known about their longer-term effects on functional outcomes. We investigated the trajectory of psychological symptoms after stroke and studied their impact on physical functional recovery.


METHODS
The Stroke Outcomes Study was a prospective cohort study conducted in West Yorkshire, UK, from 2002 to 2006. Baseline assessments were conducted within 2 to 6 weeks of an index stroke event and follow-up at 9, 13, 26, and 52 weeks thereafter. Measures of psychological symptoms (assessed using the 28-item General Health Questionnaire) and function (modified Barthel Index) were completed at each visit. Longitudinal latent class analysis identified psychological symptom trajectories. Logistic regression modeled poor functional outcome. Multiple imputation was used as a sensitivity analysis.


RESULTS
Five hundred ninety-two (55% of eligible patients) consented to participate. Four hundred forty-four (76%) complete sets of data (5 time points) were obtained for analysis. Four distinct classes of patients emerged from the analyses based on trajectory of psychological symptoms in the first 26 weeks after stroke. There was a strong association between functional outcome and class as defined by psychological symptom trajectory, which was not explained by age, sex, or initial disability after stroke.


CONCLUSIONS
Currently, the assessment of psychological distress is concentrated in the first weeks after stroke. Our results suggest that the timing of assessment and intervention needs to be reconsidered to take into account the trajectory of psychological symptoms rather than assessment at a single time point.
West
Robert
R
Leeds Institute of Health Sciences, The University of Leeds, Leeds, UK.
Hill
Kate
K
Hewison
Jenny
J
Knapp
Peter
P
House
Allan
A
D000203:Activities of Daily Living / Q000523:psychology; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003863:Depression / Q000150:complications / Q000175:diagnosis* / Q000523:psychology; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D011446:Prospective Studies; D011569:Psychiatric Status Rating Scales; D020127:Recovery of Function; D012720:Severity of Illness Index; D020521:Stroke / Q000150:complications / Q000523:psychology*; D000071939:Stroke Rehabilitation; D011795:Surveys and Questionnaires; D016896:Treatment Outcome