Influence of Including Patients with Premorbid Disability in Acute Stroke Trials: The HeadPoST Experience

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dc.contributor.authorWang, Xia
dc.contributor.authorMoullaali, Tom J.
dc.contributor.authorOuyang, Menglu
dc.contributor.authorBillot, Laurent
dc.contributor.authorSandset, Else Charlotte
dc.contributor.authorSong, Lili
dc.contributor.authorDelcourt, Candice
dc.contributor.authorHackett, Maree L.
dc.contributor.authorWatkins, Caroline L.
dc.contributor.authorRobinson, Thompson G.
dc.contributor.authorYang, Jie
dc.contributor.authorLavados, Pablo
dc.contributor.authorBrunser, Alejandro
dc.contributor.authorMuñoz Venturelli, Paula
dc.contributor.authorOlavarría, Verónica
dc.contributor.authorArima, Hisatomi
dc.contributor.authorMiddleton, Sandy
dc.contributor.authorPontes-Neto, Octávio M.
dc.contributor.authorPandian, Jeyaraj Durai
dc.contributor.authorRogers
dc.contributor.authorRogers, Kris
dc.contributor.authorAnderson, Craig S.
dc.date.accessioned2022-05-04T16:14:38Z
dc.date.available2022-05-04T16:14:38Z
dc.date.issued2021
dc.description.abstractBackground: Patients with premorbid functional impairment are generally excluded from acute stroke trials. We aimed to determine the impact of including such patients in the Head Positioning in acute Stroke Trial (HeadPoST) and early additional impairment on outcomes. Methods: Post hoc analyses of HeadPoST, an international, cluster-randomized crossover trial of lying-flat versus sitting-up head positioning in acute stroke. Associations of early additional impairment, defined as change in modified Rankin scale (mRS) scores from premorbid levels (estimated at baseline) to Day 7 ("early ΔmRS"), and poor outcome (mRS score 3-6) at Day 90 were determined with generalized linear mixed model. Heterogeneity of the trial treatment effect was tested according to premorbid mRS scores 0-1 versus 2-5. Results: Of 8,285 patients (38.9% female, mean age 68 ± 13 years) with complete data, there were 1,984 (23.9%) with premorbid functional impairment (mRS 2-5). A significant linear association was evident for early ∆mRS and poor outcome (per 1-point increase in ΔmRS, adjusted odds ratio 1.20, 95% confidence interval 1.14-1.27; p < 0.0001). Patients with greater premorbid functional impairment were less likely to develop additional impairment, but their risk of poor 90-day outcome significantly increased with increasing (worse) premorbid mRS scores (linear trend p < 0.0001). There was no heterogeneity of the trial treatment effect by level of premorbid function. Conclusions: Early poststroke functional impairment that exceeded premorbid levels was associated with worse 90-day outcome, and this association increased with greater premorbid functional impairment. Yet, including premorbid impaired patients in the HeadPoST did not materially affect the subsequent treatment effect.es
dc.description.versionVersión Publicadaes
dc.identifier.citationWang X, Moullaali TJ, Ouyang M, Billot L, Sandset EC, Song L, Delcourt C, Hackett ML, Watkins CL, Robinson TG, Yang J, Lavados PM, Brunser A, Olavarría VV, Muñoz-Venturelli P, Arima H, Middleton S, Pontes-Neto OM, Pandian JD, Rogers K, Anderson CS. Influence of Including Patients with Premorbid Disability in Acute Stroke Trials: The HeadPoST Experience. Cerebrovasc Dis. 2021;50(1):78-87. doi: 10.1159/000512608. Epub 2021 Jan 12. PMID: 33434907.es
dc.identifier.urihttps://doi.org/10.1159/000512608es
dc.identifier.urihttp://hdl.handle.net/11447/6055
dc.language.isoenes
dc.subjectAcute strokees
dc.subjectAcute stroke trialses
dc.subjectClinical outcomees
dc.titleInfluence of Including Patients with Premorbid Disability in Acute Stroke Trials: The HeadPoST Experiencees
dc.typeArticlees
dcterms.sourceCerebrovascular Diseaseses

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