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

Abstract

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 REHABILITATION

• Despite 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.

Keywords:

• Neurobehavioural disability
• stroke
• acquired brain injury
• behaviour change rehabilitation
• cognition

Acknowledgements

The authors would also like to acknowledge the contribution of the following individuals during the completion of this study: Jamie Byrne, Holly McManus, Megan O’Neill, and Cameron Redpath, in addition to the nursing staff on NW2 of the Kingston Centre, Monash Health, and the participating survivors of stroke and their families.

Disclosure statement

The authors declare no conflicts of interest.

Additional information

Funding

This project was partially funded by the Lions John Cockayne Memorial Fellowship Trust Fund. AGT was funded by a National Health and Medical Research Council fellowship (1042600).