A longitudinal examination of the frequency and correlates of self-reported neurobehavioural disability following stroke.

PURPOSE: To determine the frequency, impact, and factors associated with self-reported neurobehavioural disability (NBD) in individuals with stroke. A secondary aim was to examine the course of self-reported NBD over time and associations with outcomes. METHODS: Eighty-seven participants admitted for inpatient rehabilitation post-stroke completed the St Andrew's-Swansea Neurobehavioural Outcome Scale. Demographic and stroke details and measures of functional disability, cognitive impairment, mood, and self-rated impact of NBD symptoms were completed. Twenty-seven participants and 19 close-others were reassessed three to six months following discharge. RESULTS: Overall reporting of neurobehavioural problems was infrequent. The domains of interpersonal and cognitive difficulties were the most commonly identified but were still only reported occasionally. However, even mild NBD was significantly correlated with negative impact. Greater self-reported NBD was significantly correlated with greater functional dependence, anxiety, and depression during inpatient rehabilitation. Self-reports of NBD remained stable over time and, at follow-up, was significantly correlated with depressive symptoms both in participants with stroke and close-others. CONCLUSIONS: In survivors of stroke, self-report of NBD is associated with poor outcomes in function, anxiety, and depression. These findings highlight the importance of routine and comprehensive assessment and intervention to manage NBD following stroke.IMPLICATIONS FOR REHABILITATIONDespite relatively infrequent self-reporting, presence of NBD remained stable across a six month follow-up period following rehabilitation which highlights the potential persistent nature of these difficulties.Even mild levels of self-reported NBD were associated with emotional distress in both stroke survivors and their significant others indicating a need for relevant interventions to support long-term outcomes.Routine screening for the presence of NBD is recommended to facilitate early detection and intervention to optimise post-stroke recovery.

Agreement between patients and nurses of neurobehavioral disability following stroke in an inpatient rehabilitation setting.

Purpose: To investigate the level of agreement of neurobehavioral disability following stroke.Methods: Stroke patients and nurses were recruited from an inpatient neurorehabilitation facility. In total, 58 stroke patient-nurse pairs completed the St Andrew's-Swansea Neurobehavioral Outcome Scale questionnaire.Results: Agreement levels of neurobehavioral disability varied across five behavior subdomains. Cognition and Interpersonal behaviors were reported as more prevalent according to nurses (39% and 36%) versus patients (14% and 7%). Agreement levels between the two groups was fair for these domains (ICC <0.60). Percentage category agreement methods revealed high patient-nurse agreement for Communication, Inhibition, and Aggression behaviors but overall reporting of these problems was very low or absent. Patient demographics and stroke variables did not predict the pattern of results. Lower patient-nurse agreement was moderately associated with older age (rs = 0.37, p = 0.01) and increased experience of nurse (rs = 0.38, p = 0.01) but only for the Cognition-related domain. Agreement of impact of neurobehavioral disability was none to slight for both groups across all neurobehavioral domains (κ <0.20).Conclusions: Neurobehavioral disability is common in the early recovery phase after stroke and is viewed differently with regards to frequency, type, and impact between patients and their nurses. Research and clinical training in the management of stroke-related neurobehavioral disability is required.Implications for rehabilitationNeurobehavioral disability (NBD) following stroke is commonly seen in the early stages of recovery and requires careful evaluation by stroke survivors and rehabilitation staff.Many patients may disagree with their clinician that they are exhibiting NBD, which may compromise the therapeutic relationship.We need to better understand factors underlying lower reporting of NBD by patients (denial or reduced self-awareness) to help guide management in stroke rehabilitation settings.

Neurobehavioral disability in stroke patients during subacute inpatient rehabilitation: prevalence and biopsychosocial associations.

BACKGROUND AND OBJECTIVES: There are scarce data on post-stroke neurobehavioral disability (NBD). The aim of this study was to identify the prevalence of NBD in a subacute inpatient stroke population and examine potential associations with demographic, stroke-related, functional and psychosocial variables. METHODS: 82 survivors of stroke were consecutively recruited during their inpatient rehabilitation admission. Nursing staff rated NBD in patients using the St Andrews -Swansea Neurobehavioral Outcome Scale (SASNOS). Measures of patient functional independence (FIM), cognition (MoCA), and mood symptoms (HADS) were collected in addition to nursing reports of whether observed NBD negatively impacted on the patient or those around them. RESULTS: NBD relating to interpersonal relationships (44.4% of participants) and cognition (52.4%) were highly prevalent within the sample while NBD relating to inhibition (1.2%), aggression (3.6%), and communication (2.5%) were relatively rare. Presence of NBD was significantly associated with reduced functional independence (rs=0.39, p < 0.01) and associated with trends in cognitive impairment (rs=0.29, p = 0.03), increased anxiety (rs=-0.43, p = 0.02) and depressive symptoms (rs=-0.43, p = 0.02). Presence of NBD was significantly correlated with negative impact to the patient and those around them across all SASNOS domains (rs range 0.42 - 0.45, all p ≤ 0.01). CONCLUSIONS: NBD is common within a subacute stroke inpatient population, particularly interpersonal and cognitive difficulties and preliminary analyses indicate associations with reduced functional ability, cognition and mood. There is a need to provide education and support to clinicians to facilitate routine assessment and management of NBD following stroke.