Stroke impairment categories: A new way to classify the effects of stroke based on stroke-related impairments.
Matthew Gittins, David Lugo-Palacios, Andy Vail and 4 others
PMID 33131321WHAT IT FOUND
Stroke patients fall into seven distinct impairment groups.
These groups predict different therapy needs and outcomes. Motor-Cognitive-Sensory strokes are most common. Loss of Consciousness strokes have highest mortality. Clinicians can use these categories to benchmark expected therapy doses and discharge destinations.
Key findings
01Seven clinically meaningful stroke impairment categories were created from national audit data, with Motor-Cognitive-Sensory being the most common (29.7%) and Loss of Consciousness the least (6.4%).
02The categories show a clear gradation in outcomes, with Loss of Consciousness strokes having 49% inpatient mortality and 90% dependence at discharge, compared to lower severity categories.
03Therapy requirements vary significantly by category, with patients having cognitive or communication impairments much more likely to be referred for speech and language therapy (60-70%) than those with motor-only impairments (35-48%).
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTsWhat it means for SLPs
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What it does not show
The classification relies on the NIHSS, which does not assess important impairments like memory, continence, or swallowing. Impairments were only recorded as present or absent on admission, ignoring severity and changes over time. The study uses observational audit data, which may be subject to reporting bias and inaccuracies in therapy time recording. The categories describe group averages and may not predict individual patient outcomes precisely.
Declared interests
Professors Tyson, Vail, Bowen and Dr Bray declare research grant funding from NIHR.
The easy way to misread this
Do not use these categories to deny therapy or predict individual recovery definitively. The study shows group trends, but the authors warn against 'pigeon-holing' patients. The NIHSS also misses key impairments like swallowing and memory, so clinical judgement must supplement this classification.