Reporting "specific abilities" after major stroke to better describe prognosis.
Visvanathan A., Whiteley W., Mead G., Lawton J., Doubal FN., Dennis M.
IntroductionIf health professionals are to involve major stroke patients and their families in making decisions about treatments, they need to describe prognosis in terms that are easily understood. We suggest that referring to "specific abilities", such as ability to be independent, walk, talk, eat normally, be continent, live without severe pain, live without major anxiety or depression and to live at home may be more easily understood than terms such as disabled based on the modified Rankin scale (mRs).ObjectiveWe aimed to describe the "specific abilities" and quality of life of patients in each mRs level at six months after major stroke.Patients and methodsA longitudinal cohort study of patients admitted to hospital with major stroke with follow up at six months.ResultsWe recruited 403 patients, mean age 77.5yrs. The number (%) in each mRs level at six months was 0 (no problems): 8(2%), 1: 45(11.2%), 2: 7(1.7%), 3: 149(37.1%), 4: 46(11.4%), 5: 36(9.0%) and 6(dead) 111(27.6%). Patients within each mRs level varied with respect to their "specific abilities" and quality of life. For example, of the 36(9%) patients with mRs 5, 30(83%) could talk, 14(39%) were continent, 33(92%) were not in severe pain, 22(61%) did not have major anxiety/depression and 5(14%) could live at home. Their median utility (derived from HRQoL) was -0.08 (range -0.35 to 0.43).Discussion and conclusionsDescribing prognosis with the mRs does not convey the variation in specific abilities and HRQoL amongst patients with major stroke. Therefore, describing prognosis in terms of "specific abilities" may be more appropriate.