Home-Time as a Surrogate Measure for Functional Outcome After Stroke: A Validation Study

Area of Science:

• Neurology
• Public Health
• Health Services Research

Background:

• Functional outcome assessment is crucial for stroke patient management.
• Home-time, a measure of time spent outside institutional care, has shown potential as an outcome indicator.
• Understanding its utility across different stroke types and time points is important, especially in non-Western populations.

Purpose of the Study:

• To investigate the correlation between home-time and modified Rankin Scale (mRS) scores in a non-Western stroke population.
• To analyze these correlations at various time points (90, 180, 365 days) post-stroke.
• To evaluate home-time's predictive performance for good functional outcomes in different stroke subtypes.

Main Methods:

• Utilized linked data from multi-center stroke registries and a national health insurance claims database.
• Functional outcomes were assessed using the modified Rankin Scale (mRS).
• Home-time was derived from claims data; Spearman correlation and AUC analysis were employed.

Main Results:

• Included 7959 patients; mRS data available for 6809 (90 days), 6694 (180 days), 4330 (365 days).
• High correlation between home-time and mRS in ischemic (rho -0.69 to -0.83) and hemorrhagic stroke (rho -0.86 to -0.88).
• Weaker correlation in transient ischemic attack (TIA) (rho -0.32 to -0.58); excellent predictive discrimination for ischemic/hemorrhagic stroke (AUCs >0.8/>0.9) and good for TIA (AUCs >0.7).

Conclusions:

• Home-time is highly correlated with mRS scores in ischemic and hemorrhagic stroke.
• Home-time demonstrates excellent discrimination in predicting good functional outcomes.
• Home-time can serve as a valid surrogate measure for functional outcome assessment after stroke.