Acute stroke severity only partially explains perceived disabilities and overall recovery after three months.

The aim of this study was to investigate to what extent stroke severity, as assessed in the acute phase, is related to perceived disabilities and overall recovery after three months.

The study is based on data from the Lund Stroke Recovery Study (LSRS), which includes a population-based sample of individuals with first-ever ischemic stroke in southern Sweden. Participants were consecutively included in the acute phase after stroke and followed up after 3 months. Stroke severity was assessed using the National Institutes of Health Stroke Scale (NIHSS) at discharge from the stroke unit. Perceived disabilities and overall recovery were assessed using the Stroke Impact Scale (SIS) at 3 months. SIS domain scores (0-100) were analyzed descriptively in relation to stroke severity (categorized NIHSS score). Linear regression analysis was performed with perceived overall recovery as the dependent variable and stroke severity as the main explanatory variable.

In total, 152 participants (median age 73 years, 36% women) had complete data on both the NIHSS at discharge and the SIS at three months. The majority were independent before stroke. According to the NIHSS score, 137 (90%) had a mild stroke, whereof 59 (39%) had a NIHSS score of zero. The remaining 10% had a moderate to severe stroke. Most disabilities were reported in the SIS domains ‘emotions’ (median 78, IQR 64-94), ‘participation’ (median 81, IQR 54-100) and ‘strength’ (median 88, IQR 75-100). The extent and type of disabilities, as well as overall recovery, were related to stroke severity, but the individual variation was large. Even those with an NIHSS score of zero reported remaining disabilities at three months. Physical disabilities (e.g., hand function, ADL) were more common in moderate to severe stroke. Stroke severity explained approximately 21% of the variation in perceived overall recovery at three months (R-square 0,212, p0.003). Controlling for age, sex and comorbidities did not largely change the results.

Although perceived disabilities and recovery were related to stroke severity on group level, a score of zero on the NIHSS at discharge from the stroke unit was not a guarantee for a full recovery at three months. Stroke severity only explained approximately one fifth of the variation in perceived overall recovery, indicating that NIHSS scores in the acute stage does not provide a sufficient indication of future recovery.

Health care professionals should be aware that even individuals with mild stroke may require rehabilitation and support, particularly with emotional well-being and participation. Therefore, it is crucial to provide multidisciplinary assessments, as well as routine follow-ups, for all stroke patients, regardless of stroke severity.