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Long-Term Functioning of Patients with Aneurysmal Subarachnoid Hemorrhage: A 4-yr Follow-up Study

Boerboom, Wendy MSc; Heijenbrok-Kal, Majanka H. PhD; Khajeh, Ladbon MD; van Kooten, Fop MD, PhD; Ribbers, Gerard M. MD, PhD

American Journal of Physical Medicine & Rehabilitation: February 2016 - Volume 95 - Issue 2 - p 112–120
doi: 10.1097/PHM.0000000000000353
Original Research Articles
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Objectives The aim was to study changes over time for multiple outcomes based on the International Classification of Functioning, Disability, and Health in patients with aneurysmal subarachnoid hemorrhage and to compare long-term outcomes with norms.

Design A prospective cohort study with 4-yr follow-up was conducted. Main outcome measures were as follows: Center for Epidemiologic Studies–Depression Scale, Fatigue Severity Scale, Trail Making Test A and B, Barthel Index, Sickness Impact Profile-68, Impact on Participation and Autonomy Questionnaire, Social Support List-12, Multidimensional Health Locus of Control Scales, COOP-WONCA Charts, and Short Form-36 Health Survey.

Results Seventy-six patients with aneurysmal subarachnoid hemorrhage were included. Measurements were done at T1 = 0.4 yrs (SD, 0.3 yrs) and T2 = 3.9 yrs (SD, 0.7 yrs) after onset. Significant improvements over time were found for Barthel Index (T1 = 18.5; T2 = 19.5; P = 0.023), Trail Making Test B (T1 = 119.4; T2 = 104.6; P = 0.025), Social Support List-12 total score (T1 = 31.1; T2 = 32.7; P = 0.042) and esteem support (T1 = 10.2; T2 = 10.9; P = 0.027), Multidimensional Health Locus of Control Scales (physician-orientation) (T1 = 21.8; T2 = 19.2; P = 0.020), and Short Form-36 Health Survey (role-emotional) (T1 = 54.6; T2 = 73.9; P = 0.048). Center for Epidemiologic Studies–Depression Scale, Fatigue Severity Scale, Sickness Impact Profile-68, and Short Form-36 Health Survey scores remained stable over time. A decline was found for COOP-WONCA (overall-health) (T1 = 2.3; T2 = 2.7; P = 0.021). At 4-yr follow-up, proportions of depression (27%) and fatigue (60%) were larger and scores on the Fatigue Severity Scale (mean [SE], 4.3 [0.2]), Trail Making Test A (mean [SE], 51.3 [3.9]), and Trail Making Test B (mean [SE], 104.4 [0.2]) were significantly worse than norm scores.

Conclusions Many patients with aneurysmal subarachnoid hemorrhage had fairly good long-term outcomes, but problems in executive functioning, mood, and fatigue still exist at long-term follow-up.

From Rijndam Rehabilitation Center (WB, MHH-K, GMR); and Departments of Rehabilitation Medicine (WB, MHH-K, GMR) and Neurology (LK, FvK), Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands.

All correspondence and requests for reprints should be addressed to: Wendy Boerboom, MSc, RoNeRes–Rotterdam Neurorehabilitation Research, Rijndam Rehabilitation Center, and Erasmus MC, University Medical Center Rotterdam, PO Box 23181, NL-3001 KD, Rotterdam, the Netherlands.

Funded by Johanna Kinderfonds (grant no 03.10.13-2003/0200) and Stichting BIO, the Netherlands. No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit on the authors or on any organization with which the authors are associated.

Material in this manuscript has not been published and is not being considered for publication elsewhere in whole or in part in any language except as an oral presentation at the American Congress of Rehabilitation Medicine in Toronto, Canada, October 2014, and as a poster presentation at the Dutch Congress of Rehabilitation Medicine in Rotterdam, the Netherlands, November 2014.

Financial disclosure statements have been obtained, and no conflicts of interest have been reported by the authors or by any individuals in control of the content of this article.

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