Subjective and objective assessments are associated for physical function but not cognitive function in community-dwelling stroke survivors

Abstract

Purpose

To investigate the relation between subjectively and objectively assessed cognitive and physical functioning among community-dwelling stroke survivors, and to examine the association of stroke severity with subjectively and objectively assessed cognitive and physical impairments.

Materials and methods

Secondary data analysis was conducted with 127 community-dwelling stroke survivors. For cognitive functioning, objective measures included the NIH Toolbox Cognition Battery and the Executive Function Performance Test; subjective measures included the Quality of Life in Neurological Disorders Applied Cognition. Objective and subjective physical functioning was measured by the NIH Toolbox 2-Minute Walk Test and the Patient-Reported Outcomes Measurement Information System Physical Function, respectively.

Results

A positive correlation was observed between subjective and objective physical functioning, whereas the correlation between subjective and objective cognitive functioning was nonsignificant. Stroke severity was associated with objective cognitive impairment and objective and subjective physical impairment, but not subjective cognitive impairment.

Conclusions

The lack of association between objective and subjective cognitive functioning challenges the conventional assumption that perceived functioning reflects actual performance. We recommend using both objective and subjective measures to accurately identify cognitive and physical impairment following stroke.

Implications for Rehabilitation

• Subjective cognitive functioning is not associated with objective cognitive functioning, suggesting that solely relying on stroke patients’ reports is inadequate and may inaccurately estimate patients’ actual deficits.

• Both objective and subjective measures should be used to accurately identify cognitive and physical impairment following stroke.

• Practitioners should be cognizant of stroke patients’ behavioral signs associated with underlying cognitive problems that warrant further evaluation.

Keywords:

• Stroke
• cognition
• physical function
• subjective assessment
• objective assessment

Disclosure statement

No potential competing interest was reported by the author(s).

Additional information

Funding

The main study was supported by the National Institute on Disability, Independent Living, and Rehabilitation Research under Grant [number H133B090024; PI: Heinemann, A.W.]. This study was supported by the Program in Occupational Therapy Dissertation Fund, Washington University in St. Louis.