Outcome assessment of stroke convalescence using multiple scales based on different dimensions

BACKGROUND: Convalescence is an important stage of stroke treatment. A lot of patients have somatic and mental disorders at various degrees. The primary standard can only reflect partial conditions of somatic disorder; in addition, multiple dimensions of patients at the phase of stroke convalescence are further observed by using a lot of standards, such as signs and symptoms of traditional Chinese medicine, daily activity and psychological status. OBJECTIVE: To analyze the outcome assessments of the cases of stroke convalescence measured with different criteria consisting of various dimensions by a cross-sectional investigation of the condition of stroke convalescent patients. DESIGN: Scale evaluation. SETTING: Departments of Clinical Epidemiology Exploratory Development and Neurology, the Second Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine; National Center for Training of Design, Measurement and Evaluation in Clinical Research,Guangzhou University of Traditional Chinese Medicine. PARTICIPANTS: A total of 194 stroke convalescent patients treated in the Second Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine from July 26, 2000 to February 28, 2001 were taken as subjects of the study. There were 126 males and 68 females aged from 40 to 89 years, and the illness course ranged from 14 to 181 days. All patients met diagnosis-treatment criteria of stroke (the second version)[DTCS(V2.0)] and various kinds of diagnostic points of cerebrovascular diseases; moreover, all patients provided confirmed consents. METHODS: They were assessed by assessment methods including the following assessment instruments: DTCS(V2.0), self-designed scale of traditional Chinese medicine (TCM) symptoms (28 symptoms and physical signs were scored as 0, 1, 2 marks from none to severity), modified Edinburgh-Scandinavia stroke scale (a total of 45 marks, 0 to 15 marks as mild defect, 16 to 30 as moderate defect, 31 to 45 as severe defect), modified Barthel activities of daily life (ADL) index (a total of 100 marks, less than 60 marks as unable self-care), vitality and mental health (subscales derived from Health Survey Questionnaire, SF-36). The collected data from scales and inter-scale correlation were processed by the statistic methods mainly including descriptive analysis, Spearmen correlation analysis, factor analysis, etc. MAIN OUTCOME MEASURES: ① Average scores of scales and criteria; ② correlation between modified Edinburgh-Scandinavia stroke scale and other scales. RESULTS: All of the patients completed the assessment, and analyzed in the final analysis. ① The average scores of the scales and criteria: The average scores of DTCS(V2.0), self-designed scale of TCM symptoms, modified Edinburgh-Scandinavia stroke scale, modified Barthel ADL index, vitality and mental health scales were 6.51±6.29, 13.73±6.97, 7.56±7.35, 63.58±23.68, 52.79±23.32 and 62.83±22.75 respectively. ② Correlation between modified Edinburgh-Scandinavia stroke scale and other scales: The Spearman correlation coefficients (R ’) of modified Edinburgh-Scandinavia stroke scale with diagnosis-treatment criteria of stroke, scales of TCM symptoms, modified Barthel ADL index, vitality scale and mental health scale were 20.885, 0.302, -0.824, -0.294 and -0.258 respectively. CONCLUSION: The modified Edinburgh-Scandinavia stroke scale and DTCS(V2.0) shared the same assessment dimension, so they can be mutually alternated in some clinical practices. Discrepancy in measurements of health status was gained due to the diverse dimensions applied in outcome assessments. It is necessary to build up a multi-dimensional assessment criteria system, such as signs and symptoms, daily activities and psychological status, for assessing the stroke convalescent cases in a more comprehensive scope and reflecting the efficacy of TCM treatment scientifically.