Patient Centered Outcomes in Stroke: Utility-Weighted Modified Rankin Scale results in a community-based study

Carlos Delfino ¹ Gabriel Cavada ² Lorena Hoffmeister ³ Pablo Lavados ^2,4 Paula Munoz Venturelli ^1,4,5*

• ¹ Instituto de Ciencias e Innovación en Medicina, Facultad de Medicina Clínica Alemana Universidad del Desarrollo, Santiago, Chile
• ² Unidad de Investigación y Ensayos Clínicos, Clínica Alemana de Santiago, Facultad de Medicina Clínica Alemana Universidad del Desarrollo, Santiago, Chile, Santiago, Chile
• ³ Instituto de Salud Pública, Universidad Andrés Bello, Las Condes, Santiago Metropolitan Region (RM), Chile
• ⁴ Servicio de Neurología, Departamento de Neurología y Psiquiatría, Clínica Alemana de Santiago, Facultad de Medicina Clínica Alemana Universidad del Desarrollo, Santiago, Chile
• ⁵ The George Institute for Global Health, Faculty of Medicine, University of New South Wales,, Sydney, Australia

The transformation of modified Rankin Scale (mRS) scores based on the corresponding utilities of health-related quality of life questionnaires can facilitate the capture of Patient-Centered Outcomes (PCO) in stroke. We aimed to derive utility-weighted modified Rankin Scale (UW-mRS) values by mapping mRS functional status to EQ-5D-3L scores in a population-based cohort of stroke patients.The UW-mRS was obtained by analysing the EQ5-D-3L and mRS scores at 180 days after any stroke in the ÑANDU study, a large prospective community-based study in Chile. The mRS prediction was estimated using a linear regression adjusted by the EQ-5D-3L value.Generalized linear and binary logistic regression models were constructed to determine influencing factors of the UW-mRS, using STATA software (version 18.0).We included 773 patients presenting with any stroke during 2015-2016: 48% were female, with a mean age of 71 years (SD 13.8), and 85% had an acute ischemic stroke (AIS). 82% of patients had a low socioeconomic status, 50% had less than 12 years of formal education, and only 32% lived in urban areas. UW-mRS values for mRS categories 0-6 at 180 days were 0.913, 0.694, 0.425, 0.249, -0.102, -0.347 and 0 respectively. Multivariable analysis identified age>70 years (Coefficient β [β] -0.038 [Standard error SE 0.018], p= 0.032), prior mRS score 3-5 (β -0.556 [SE 0.197], p<0.001), ischemic stroke (β -0.066 [SE 0.025], p=0.010), and National Institutes of Health Stroke Scale (NIHSS) at admission>5 (β -0.015[SE 0.002], p<0.001) as significant predictors of worse UW-mRS scores (R²=70%) in the overall group. Sex-disaggregated analysis showed that age>70 years was a significant predictor in males (β -0.069 [SE 0.024], p=0.006), while presenting an AIS had a greater impact on female's worse UW-mRS score (β -0.087 [SE 0.033], p=0.010).These results present UW-mRS values derived from a population-based stroke study. Key determinants of health-related quality of life in post-stroke patients included age, prior disability, and stroke severity. Sex-disaggregated analysis revealed age being significant for males and AIS for females. Incorporating PCO as UW-mRS in stroke research can provide a more nuanced understanding of the impact of stroke on survivors, offering valuable insights for clinical decision-making and rehabilitation strategies across diverse contexts.