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. 2021 Mar;35(3):446-458.
doi: 10.1177/0269215520966473. Epub 2020 Nov 1.

Stroke impairment categories: A new way to classify the effects of stroke based on stroke-related impairments

Matthew Gittins  1 , David Lugo-Palacios  2 , Andy Vail  1 , Audrey Bowen  3 , Lizz Paley  4 , Benjamin Bray  5 , Sarah Tyson  6
Affiliations

Stroke impairment categories: A new way to classify the effects of stroke based on stroke-related impairments

Matthew Gittins et al. Clin Rehabil. 2021 Mar.

Abstract

Objective: To create a classification system based on stroke-related impairments.

Data source: All adults with stroke admitted for at least 72 hours in England, Wales and Northern Ireland from July 2013 to July 2015 extracted from the Sentinel Stroke National Audit Programme.

Analysis: Impairments were defined using the National Institute of Health Stroke Scale scores at admission. Common combinations of impairments were identified based on geometric coding and expert knowledge. Validity of the classification was assessed using standard descriptive statistics to report and compare patients' characteristics, therapy received and outcomes in each group.

Results: Data from 94,905 patients were extracted. The items of the National Institute of Health Stroke Scale (on admission) were initially grouped into four body systems: Cognitive, Motor, Sensory and Consciousness. Seven common combinations of these impairments were identified (in order of stroke severity); Patients with Loss of Consciousness (n = 6034, 6.4%); those with Motor + Cognitive + Sensory impairments (n = 28,226, 29.7%); Motor + Cognitive impairments (n = 16,967, 17.9%); Motor + Sensory impairments (n = 9882, 10.4%); Motor Only impairments (n = 20,471, 21.6%); Any Non-Motor impairments (n = 7498, 7.9%); and No Impairments (n = 5827, 6.1%). There was a gradation of age, premorbid disability, mortality and disability on discharge. People with the most and least severe categories were least likely to receive therapy, and received least therapy (-20 minutes/day of stay) compared to -35 minutes/day of stay for the moderately severe categories.

Conclusions: A classification system of seven Stroke Impairment Categories has been presented.

Keywords: Stroke; disability; length of stay; occupational therapy; physiotherapy; psychology; rehabilitation; speech and language therapy.

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Conflict of interest statement

Declaration of conflicting interests: The author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: Professors Tyson, Vail, Bowen and Dr Bray declare research grant funding from NIHR. Prof Bowen was until 2016 a member of the Intercollegiate Stroke Working Party that produces SSNAP from which the SSNAPIEST data were drawn and her University salary is part-funded by a personal award from Stroke Association. Professor Tyson is currently a member of the Intercollegiate Stroke Working Party

Figures

Figure 1.
Figure 1.
The number and percentage of stroke patients with each individual National Institute of Health Stroke Scale defined impairments broken down by system impairments. The greyscale represents the different system impairments (left to right; Loss of Consciousness, Cognitive Impairments, Motor Impairments and Sensory Impairments) measured at admission in patients who were hospitalised after 3 days.
See this image and copyright information in PMC

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