Self-perceived impact of stroke
(SALGOT) and the SALGOT extended study (10, 11). The
SALGOT study included all patients with first clinical stroke at
Sahlgrenska University Hospital in Gothenburg, Sweden during
18 months in 2009–10. Inclusion criteria were: first-ever stroke
based on World Health Organization (WHO) criteria, Internatio-
nal Classification of Disease (ICD) codes, ischaemic stroke (I63)
and haemorrhagic stroke (I61); living in the Gothenburg urban
area (within 35 km of the hospital); age 18 years or older; able
to communicate in Swedish prior to the stroke; and impaired
arm function on day 3. Exclusion criteria were: impaired arm
function prior to stroke onset; short life expectancy; and not able
to communicate in Swedish prior to the stroke. In the SALGOT
the participant were assessed on 8 occasions during the first year
post-stroke. A set of questionnaires were sent out 5 years later
to the surviving participants. Participants in the present study
should have participated in the 1-year follow-up in the SALGOT
study, as well as responded to the 5-year follow-up survey. The
STROBE guidelines for observational studies were followed.
Clinical characteristics from stroke onset were obtained from
medical charts. This includes National Institute of Health Stroke
Scale (NIHSS) at admittance, the modified Rankin Scale (mRS,
0 = no symptoms, 5 = severe dependency) at discharge from
hospital, which measures dependence in the daily activities after
stroke and can be seen as a measure of stroke severity (12). The
Charlson Comorbidity Index (CCI) (13) is a grading system
in which various factors of a patient give different amounts of
points depending on age and severity of a disease or syndrome.
For comorbidity, the CCI is used, based on data from medical
charts from the time at the stroke unit. The set of questionnaires
included the Stroke Impact Scale (SIS) (8), the Impact on Parti-
cipation and Autonomy (IPA) (14) and the European Quality of
Life 5 dimensions (EQ-5D) (15). The responses were gathered
by a face-to-face interview at 1-year post-stroke and by regular
mail 5 years post-stroke.
The SIS is a multidimensional self-report questionnaire that
evaluates the impact of stroke from the participant’s perspec-
tive, using 59 questions across 8 dimensions; strength, memory
and thinking, emotion, communication, ADL, mobility, hand
function, and participation (16). The questions within each
dimension are scored 1–5, where 5 is best (least problems).
The scores of each dimension are then converted into a value
0–100, where a score of 100 indicates no problems.
The IPA is a questionnaire with 5 different subscales; auto-
nomy indoors, family role, autonomy outdoors, social life and
relationships, and work and education. In total, the questionnaire
consists of 32 questions or items (14). The questions pertaining
to work and education are answered only for those who are in
paid or voluntary work or for those who wish to enter further
education. If not of working age the “not applicable” option
could be used. Each question has a scoring range from 0 to 4,
where 0 is very good and 4 is very poor. In order for a subscale to
be valid, a minimum of 75% of the questions must be completed.
The EQ-5D is a questionnaire that measures general health
status across 5 dimensions: mobility, self-care, common activi-
ties, pain/discomfort, and anxiety/depression. For each domain
there are 3 grades: no problems, moderate problems, or severe
problems (15).
Statistical methods
The data were processed and analysed in IBM Statistical
Package for Social Sciences (SPSS) version 22 for Windows.
p < 0.05 is considered statistically significant in the present study.
Drop-out analysis was performed with regards to age, sex, stroke
severity (NIHSS at admittance) and global disability at discharge
661
Interviewed face to face either at home
or at clinic at 1-year post stroke, n=79
Did not respond to mail survey five-year post stroke,
n=34
deceased, n=8
declined due to illness, n=2
did not respond, n=18
no valid address could be found, n=5
Responded to questionnaires at 5 years, n=45
Fig. 1. Flow chart of the population selection procedure starting at year
1 post-stroke with inclusion at 5 years.
according to mRS. The drop-out analysis was performed with
χ 2 test regarding sex and mRS and by Mann–Whitney U test for
NIHSS and age. Wilcoxon signed-rank test was used to check
for statistically significant differences over time between 2
related samples (16). Correlations were analysed by Spearman
rank correlation, and correlations less than 0.3 are considered
weak, between 0.3 and 0.5 moderate, and >0.5 strong (17).
Ethical considerations
The Regional Ethical Review Board approved the study: Dnr
225-8 with a complementary approval T801-10, as well as Dnr
400-13. All participants gave informed oral and written consent.
RESULTS
Seventy-nine persons participated at the 1-year follow-
up, of whom 45 participated at the 5-year follow-up,
and were included in the present study (Fig. 1). The
number of participants that have answered the ques-
tionnaire within each assessment varies. The mean age
at stroke onset was 63.8 years and the majority of par-
ticipants were men (Table I). There were no significant
differences regarding sex (p = 0.116) or age (p =0.800)
Table I. Clinical characteristics of the population, n = 45
Clinical characteristics
Age at stroke onset, years, mean (SD)
Sex, n (%)
Male
Female
Type of stroke*, n (%)
Ischaemic stroke
Intracerebral haemorrhage
mRS at hospital discharge, n (%)
2
3
4
Comorbidity, n (%)
No comorbidity
Mild comorbidity
Moderate comorbidity
Severe comorbidity
Time to follow-up, years, mean (range)
Age at follow-up, years, mean (SD)
63.8 (11.85)
28 (62)
17 (38)
35 (80)
9 (20)
8 (17)
15 (33)
22 (48)
15 (33)
21 (47)
8 (18)
1 (2)
4.9 (4–5.8)
68.3 (11.73)
*n = 44. SD: standard deviation; mRS: modified Rankin Scale.
J Rehabil Med 51, 2019