662
E. Skoglund et al.
Table II. Self-perceived impact of stroke according to Stroke Impact Scale after 1 and after 5 years. Differences in change over time
were analysed by Wilcoxon signed-rank test
1 year
5 years
SIS n Mean (SD) Median (min–max) Mean (SD) Median (min–max) p-value
Strength
Memory & thinking
Emotion
Communication
Activities of daily living
Mobility
Hand function
Participation 43
44
43
43
44
43
44
34 68.2
87.4
79.7
90.9
80.2
83.0
62.2
68.4 75
93
83
96
90
89
78
62 58.7
82.6
66.8
85.9
79.5
75.1
58.8
54.4 69
93
67
93
91
83
70
60 0.002
0.085
< 0.001
0.010
0.932
< 0.001
0.227
0.002
(23.0)
(16.1)
(16.8)
(13.9)
(23.6)
(19.2)
(40.2)
(28.1)
(12–100)
(29–100)
(33–100)
(29–100)
(30–100)
(33–100)
(0–100)
(16–100)
(27.3)
(21.1)
(18.9)
(18.4)
(23.9)
(24.9)
(36.3)
(22.2)
(0–100)
(14–100)
(19–94)
(18–100)
(9–100)
(17–100)
(0–100)
(0–80)
For the Stroke Impact Scale (SIS), 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. Significant values are shown in bold.
SD: standard deviation.
between the non-responders (n = 34) and responders
at 5 years (n = 45). The median NIHSS at admittance
for the whole group was 7, and the difference between
responders and non-responders was not significant.
However, the non-responders had a higher mRS at
discharge (p < 0.0001). Only 3 participants reported
having had a new stroke during the 5-year follow up.
Self-perceived impact measured by the SIS was
more prominent after 5 years compared with 1-year
post-stroke, as can be seen in Table II in 5 out of 8
dimensions. After 5 years, emotion, strength and
participation were the dimensions with the most
experienced problems. The dimensions assessed as
the most impacted at 1 year were hand function and
participation, but at 5 years emotion, strength and par-
ticipation were the dimensions for which participants
experienced the most problems.
Autonomy indoors includes looking after oneself
as one wants and getting around the house when and
where one wants. At 1 year, the participants scored
very good for the indoors subscale. For all the other
subscales the median was 1, meaning good. Also at 1
year, no participant reported worse than fair, but after 5
years the worst was very poor. Out of 45 participants,
41 reported more severe consequences at 5 years for the
indoor subscale. For social life the median at 5 years
Table III. Self-perceived Impact on Participation and Autonomy
(IPA) 1 year and 5 years after stroke
1 year 5 years Median
(min–max) p-value a
1 (1–4)
1 (0–4)
1 (0–4)
1.75 (1–4)
1 (0–4)
60 (0–80) <0.001
0.073
0.887
<0.001
0.147
0.002
IPA n Median
(min–max)
Autonomy indoors
Autonomy outdoors
Family life
Social life
Work and education
SIS Participation 44
44
44
45
15
34 0 (0–2)
1 (0–4)
1 (0–4)
1 (0–3)
1 (0–4)
62 (16–100)
The IPA questionnaire states that, in order for a subscale to be valid, a minimum
of 75% of the questions need to be completed. The range is from 0–4, with
0 being the best. For the Stroke Impact Scale (SIS) a higher value indicates
a better situation. Significant values are shown in bold.
a
Differences in change over time were analysed by Wilcoxon signed-rank test.
www.medicaljournals.se/jrm
was 1.75 compared with 1 at 1 year, 1.75 falls between
good and fair on the scale. There were no participants
at 1 year who reported very poor, the worst was poor,
but at 5 years the participants with worst problems
reported that their social life was very poor. Out of
44 participants that answered the questionnaire at 5
years regarding the social life subscale, 39 experienced
more severe problems and 5 the same, none of the
participants experienced fewer problems after 5 years
compared with after 1 year. In Table III, the results of
the IPA at 1 year and at 5 years post-stroke show that
the impact was most pronounced within the autonomy
indoor (p < 0.001) and social life (p < 0.001) subscales,
where the majority of participants reported a worse
situation after 5 years compared with after 1 year.
Strongest correlations between mRS and SIS
were seen in the dimensions strength (–0.385), ADL
(–0.454) and hand function (–0.461) (Table IV). This
means that a higher level of global disability according
Table IV. Correlation of global disability assessed by modified
Rankin Scale with self-perceived impact of stroke and quality of
life at 5 years post-stroke
Modified Rankin Scale
Self-perceived impact
Strength
Memory & thinking
Emotion
Communication
Activities of daily living
Mobility
Hand function
Participation
SIS Participation
IPA Autonomy indoors
IPA Family life
IPA Social life
IPA Autonomy outdoors
IPA Work and education
Health-related QOL
EQ-5D
Correlation coefficient p-value
–0.385
–0.228
–0.230
–0.126
–0.454
–0.293
–0.461 0.010
0.132
0.133
0.415
0.002
0.053
0.001
–0.257
0.231
0.239
0.055
0.233
0.118 0.142
0.126
0.118
0.721
0.127
0.676
–0.452 0.002
The fact that the score from the Impact on Participation and Autonomy (IPA)
questionnaire has 0 as the best situation yields a negative correlation here.
IPA: Impact on Participation and Autonomy; SIS: Stroke Impact Scale; mRS:
modified Rankin Scale; EQ-5D: European Quality of Life, 5 Dimensions.
Correlation was analysed with Spearman’s rank correlation. Significant values
are shown in bold.