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Rehabilitation needs after transient ischemic attack: a perspective of patient-reported outcome measures
Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation.
2025 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background: Transient ischemic attack (TIA) has drawn increased interest in the last 20 years concerning sequalae. However, the longterm consequences and rehabilitation needs of TIA remain largely unknown. The overall aims of this thesis were to evaluate long-term disabilities after TIA and their effects on patients’ daily activities, social participation, and health-related quality of life (HRQoL). 

Methods: This thesis involved two cohorts from two different observational studies. The first cohort included 47 community-dwelling individuals in the sub-acute phase (4 months) after TIA who were included in a prospective cohort study (Study I). The second cohort was from a retrospective cohort study (Studies II–IV) assessing 431 community-dwelling adults’ rehabilitation needs, mainly in the chronic phase (1–13 years) after TIA onset. Patient comorbidities, such as hypertension and atrial fibrillation, were collected from the Riksstroke Registry in Study I and patients’ medical records in Studies II–IV. The multidimensional consequences of TIA and rehabilitation needs after TIA were assessed by five well-validated patient-reported outcome measures (PROMS), including the Fatigue Assessment Scale with added sleep-related questions, Hospital Anxiety Depression scale, simplified Modified Rankin Scale, Stroke Impact Scale 3.0 (SIS), and the EQ-5D three-level version (EQ-5D-3L). Statistical analyses were performed using SPSS v.27 and GraphPad Prism 10. 

Results: Assessments with PROMS were feasible among community-dwelling persons after a first-ever TIA in an outpatient setting (Study I). At the sub-acute stage, the most common parameter affected was mood (reported by 89% of participants), followed by bladder function (70%), sexual life (52%), strength (51%), and fatigue (26%). Symptoms of depression and anxiety were reported by 6% and 17% of participants, respectively. In Study II, long-term patient-reported fatigue was evident among 37.8% of the community-dwelling adults from 6 months up to 13 years following a TIA. Among first-ever TIA patients, 35% were fatigued, with higher mean scores than the general age-matched population. Additionally, depression, anxiety, heart disease, and atrial fibrillation were independently associated with increased perceived fatigue in the same group. This elevated perceived fatigue was significantly associated with fewer activities in everyday life. 

In Study III, the most reported perceived disabilities assessed by the SIS belonged to the emotions (80.6 SD 15.5), strength (84.2 SD 24.0), and participation (89.1 SD 18.5) domains up to the 10-year follow-up. No significant differences in SIS domains were observed over time when comparing data between the three groups (i.e. < 1 year post-TIA; 1 - 5 years post-TIA; and 5 – 10 years post-TIA). Perceived disabilities and their correlations with Activities of Daily Living / instrumental Activities of Daily Living ADL/IADL and participation were demonstrated consistently up to 10 years after TIA. 

In Study IV, we demonstrated that most first-ever TIA patients were not affected regarding HRQoL (mean 0.88 SD 0.2) as measured by index scores of the EQ-5D-3L. However, the index scores were significantly lower in the TIA with stroke group (0.77 (0.3); p < 0.001) compared to the first-ever TIA group. A preserved HRQoL was observed at a similar level from 1 to more than 10 years after the first-ever TIA (p = 0.643). The most reported sub-domain problem was pain, followed by depression/anxiety and mobility. Factors associated significantly with poorer HRQoL in this cohort (p < 0.001) were persons with recurrent TIA and stroke (odds ratio (95% CI) 0.67 (0.53–0.83)), more depression (0.59 (0.53–0.66)), anxiety (0.73 (0.68–0.79)), and perceived fatigue (0.81 (0.77-0.85)). 

Conclusion: Our findings support the screening of long-term consequences of TIA among community-dwelling individuals. Besides secondary prevention measures after TIA, tailored rehabilitation interventions could improve the everyday lives of TIA patients. 

Place, publisher, year, edition, pages
Umeå: Umeå University, 2025. , p. 46
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 2343
Keywords [en]
transient ischemic attack, fatigue, activities of daily living, participation, health-related quality of life, long-term consequence
National Category
Neurosciences Rehabilitation Medicine
Research subject
Rehabilitation Medicine
Identifiers
URN: urn:nbn:se:umu:diva-234385ISBN: 978-91-8070-596-7 (print)ISBN: 978-91-8070-597-4 (electronic)OAI: oai:DiVA.org:umu-234385DiVA, id: diva2:1929876
Public defence
2025-02-14, Aula Biologica, Umeå, 09:00 (Swedish)
Opponent
Supervisors
Available from: 2025-01-24 Created: 2025-01-21 Last updated: 2025-01-22Bibliographically approved
List of papers
1. Identifying sub-acute rehabilitation needs among individuals after transient ischaemic attack using rehab-compass as a simple screening tool in the outpatient clinic
Open this publication in new window or tab >>Identifying sub-acute rehabilitation needs among individuals after transient ischaemic attack using rehab-compass as a simple screening tool in the outpatient clinic
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2019 (English)In: Journal of Rehabilitation clinical communications, E-ISSN 2003-0711, Vol. 2, article id 1000018Article in journal (Refereed) Published
Abstract [en]

Objective: To evaluate comprehensive unmet rehabilitation needs by using a novel graphic screening tool, Rehab-Compass, among individuals in the sub-acute stage after first-ever transient ischaemic attack.

Methods: A pilot prospective cohort study investigated 47 individuals with first-ever transient ischaemic attack in an outpatient clinic setting. By using Rehab-Compass, based on well-validated patient-reported outcome measure questionnaires, this study examined comprehensive unmet rehabilitation needs among individuals at 4-month follow-up after the onset of transient ischaemic attack.

Results: Rehab-Compass identified that most participants were independent in their daily lives (modified Rankin Scale; mRS 0–1) with a relatively good quality of life (median EuroQol 5 dimensions (EQ-5D) 0.85), but certain limitations in participation in their daily lives. Rehab-Compass showed that, at 4 months after transient ischaemic attack, the most common condition affected was mood (reported by 89% of participants), followed by bladder function (70%), sexual life (52%), strength (51%) and fatigue (26%). Symptoms of depression and anxiety were reported by 6% and 17% of participants, respectively.

Conclusion: This pilot study indicates that Rehab-Compass might be a suitable simple screening tool for use in the outpatient clinic setting to identify the multidimensional rehabilitation needs of individuals after transient ischaemic attack.

National Category
Medical and Health Sciences Medical and Health Sciences
Identifiers
urn:nbn:se:umu:diva-169233 (URN)10.2340/20030711-1000018 (DOI)
Available from: 2020-03-26 Created: 2020-03-26 Last updated: 2025-01-21Bibliographically approved
2. Long-term perceived fatigue after transient ischaemic attack
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(English)Manuscript (preprint) (Other academic)
National Category
Clinical Medicine
Identifiers
urn:nbn:se:umu:diva-234383 (URN)
Available from: 2025-01-21 Created: 2025-01-21 Last updated: 2025-01-22Bibliographically approved
3. Long-term perceived disabilities up to 10 years after transient ischaemic attack
Open this publication in new window or tab >>Long-term perceived disabilities up to 10 years after transient ischaemic attack
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2021 (English)In: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 53, no 3, article id jrm00167Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: The long-term impact of transient ischaemic attack is largely unknown.

OBJECTIVES: To assess the long-term perceived impact of transient ischaemic attack and explore the influence of sex and age on these perceptions; and to evaluate the relationships between activities of daily living, participation and overall recovery, and the other domains of the Stroke Impact Scale 3.0 (SIS).

METHODS: A retrospective study among adult community-dwelling individuals from 6 months up to 10 years after onset of transient ischaemic attack. A total of 299 survivors of transient ischaemic attack responded to the SIS.

RESULTS: Most self-reported disabilities involved emotion, strength, and participation domains of SIS and remained stable until 10 years post-transient ischaemic attack. Women reported significantly more disabilities for emotion and hand function. Elderly subjects (age > 65 years) reported more disabilities for strength, mobility, hand function, activities of daily living/instrumental activities of daily living, and participation. The activities of daily living/instrumental activities of daily living, participation, and overall recovery demonstrated significant, although low-to-moderate, associations with other SIS domains after transient ischaemic attack.

CONCLUSION: The broadly perceived disabilities were demonstrated consistently and played a significant meaningful role in everyday life and recovery among community-dwelling individuals up to 10 years after a transient ischaemic attack. These findings indicate the need for long-term multi-professional follow-up with holistic rehabilitation to improve overall recovery among survivors of transient ischaemic attack.

Keywords
daily activity, long-term outcome, participation, perceived impact, Stroke Impact Scale, transient ischaemic attack
National Category
Neurology
Identifiers
urn:nbn:se:umu:diva-182099 (URN)10.2340/16501977-2808 (DOI)000743261000002 ()2-s2.0-85103305697 (Scopus ID)
Funder
Region VästerbottenThe Swedish Stroke Association
Available from: 2021-04-14 Created: 2021-04-14 Last updated: 2025-01-21Bibliographically approved
4. Lack of observed effect on health-related quality of life after transient ischemic attack
Open this publication in new window or tab >>Lack of observed effect on health-related quality of life after transient ischemic attack
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(English)Manuscript (preprint) (Other academic)
National Category
Clinical Medicine
Identifiers
urn:nbn:se:umu:diva-234384 (URN)
Available from: 2025-01-21 Created: 2025-01-21 Last updated: 2025-01-22Bibliographically approved

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