Poster The Joint Annual Meeting of the Stroke Society of Australasia (SSA) and Smartstrokes 2023

Application of Real-world Clinical Data to Understand the Profile of Arm Weakness, Pre-stroke Outcomes and Other Impairments Early Post-stroke. (#161)

Emily J Dalton 1 2 , Rebecca Jamwal 1 , Lia Augoustakis 1 , Emma Hill 1 , Hannah Johns 3 , Vincent Thijs 4 5 6 , Kate S Hayward 7
  1. Occupational Therapy, Austin Health, Heidelberg, Australia
  2. Melbourne School of Health Science, University of Melbourne, Parkville, VIC, Australia
  3. Melbourne Medical School, University of Melbourne, Parkville, Vic, Australia
  4. Neurology, Austin Health, Heidelberg, VIC, Australia
  5. Florey Institute of Neurosciences and Mental Health, Heidelberg, Vic, Australia
  6. Medicine, University of Melbourne, Parkville, VIC, Australia
  7. Physiotherapy, Medicine and Florey Institute of Neurosciences and Mental Health, University of Melbourne, Heidelberg, VIC, Australia

Background: The profile of upper limb weakness and other impairments early post-stroke may be changing. Examining the assessment completed within 24-48 hours post-stroke, recommended by the Australian Stroke Guidelines, may build an understanding of the current profile. Such an assessment can provide real-world data benefits for clinical (e.g., profile of impairments, service delivery changes) and research (e.g., recovery phenotypes) practice.

Aims: Primary aim was to determine the upper limb motor weakness profile, with a secondary aim to contextualise this profile by examining pre-stroke outcomes, other post-stroke impairments, and discharge destination.

Methods: Cross-sectional observational study. Data were extracted from the electronic medical record of a consecutive sample admitted to an acute stroke unit over 15 months. The Shoulder Abduction and Finger Extension (SAFE) score was the primary measure of upper limb weakness. Demographics (e.g., age), clinical characteristics (e.g., National Institutes of Health Stroke Scale NIHSS), pre-stroke outcomes (e.g., Clinical Frailty Scale), other post-stroke impairments (e.g., command following), and discharge destination were also extracted.

Results: 463 patients had a confirmed stroke and SAFE score (median: 74-years; NIHSS 5. 90% ischaemic). One-third of patients received ≥1 acute intervention(s). Nearly one-quarter of patients were classified as frail pre-stroke. Upper limb weakness (SAFE≤8) was present in 35% at a median of 1 day post-stroke, with most categorised with mild-moderate weakness (SAFE5-8). The most common other impairments were upper limb coordination (46%), delayed recall (41%), and upper limb sensation (26%). After a median 3-day acute admission, 52% of patients were discharged home.

Conclusion: The impairment profile was heterogenous early post-stroke. While fewer patients are presenting with upper limb motor weakness than in well-cited studies from 20 years ago, many are presenting with premorbid clinical frailty. Further research is required to tease out the impact of pre- and post-stroke impairments to identify meaningful recovery phenotypes.