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Original research
Patient-reported outcome measures after thrombectomy in patients with acute stroke: fine-tuning the modified Rankin Scale
  1. David Cano,
  2. Estefanía Montiel,
  3. Maria Baladas,
  4. Esther Sanchez-Gavilan,
  5. Carolina Paredes,
  6. Marta Rubiera,
  7. Manuel Requena,
  8. Marian Muchada,
  9. Marta Olive Gadea,
  10. Alvaro Garcia-Tornel,
  11. Carlos A Molina,
  12. Marc Ribo
  1. Stroke Unit, Department of Neurology, Vall d'Hebron University Hospital, Universitat Autonoma de Barcelona, Barcelona, Spain
  1. Correspondence to Dr Marc Ribo, Stroke Unit, Department of Neurology, Vall d'Hebron University Hospital, Universitat Autonoma de Barcelona, Barcelona, Catalunya, Spain; marcriboj{at}hotmail.com

Abstract

Background In patients with stroke undergoing endovascular treatment (EVT), long-term outcome is usually only evaluated by the modified Rankin Scale (mRS). Patient-reported outcomes (PROMs) are standardized assessments that consider clinical outcomes from the perspective of the patient. We aimed to evaluate PROMs through a smartphone-based communication platform in patients with stroke who received EVT.

Methods Consecutive patients with stroke who underwent EVT were offered to participate in the PROMs-through-App program (NORA). A set of standardized PROMs were collected at 7, 30 and 90 days after discharge. Disability was determined by clinicians (mRS) at 90 days. To characterize the potential ceiling effect of mRS in the assessment of different domains, the rate of abnormal PROMs among patients with excellent outcome (mRS 0–1) was calculated.

Results From June 2020 to October 2021, 186 patients were included. The median PROMs collection rate per patient was 80% (50–100%). A correlation was consistently seen between disability measured by mRS and the different PROMs. The rate of abnormal PROMs ranged from 20.83% (HADS at 7 days) to 59.61% (Mental PROMIS at 7 days). At 90 days, among patients with an excellent outcome, the rate of abnormal PROMs ranged from 8.7% (HADS) to 47.83% (Physical PROMIS).

Conclusions A specifically designed digital platform allows a high collection rate of PROMs among stroke patients who underwent EVT. The mRS score shows a ceiling effect and seems insufficient to fine-tune long-term clinical results. The use of PROMs may allow a better characterization of long-term outcome profiles after EVT.

  • Stroke
  • Thrombectomy

Data availability statement

Data are available upon reasonable request. Study data are available upon reasonable request to the corresponding author.

Statistics from Altmetric.com

Data availability statement

Data are available upon reasonable request. Study data are available upon reasonable request to the corresponding author.

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Footnotes

  • Twitter @marcriboj

  • Contributors MRi accepts full responsibility for the work and/or the conduct of the study, had access to the data, and controlled the decision to publish. MR conceived the study. MR and DC analyzed the data. All authors collected the data and critically reviewed the manuscript.

  • Funding This work was supported by Fundació La Marató de TV3 (20172810).

  • Competing interests MRi has modest ownership and serves on the advisory board of Methinks Software and NoraHealth; he has a consulting agreement with Medtronic, Stryker, Johnson and Johnson, Perflow Medical, Anaconda Biomed and Apta Targets. CAM has modest ownership of NoraHealth. The other authors have no disclosures directly related to whole or part of the research described in the present manuscript.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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