Stroke impairment categories: A new way to classify the effects of stroke based on stroke-related impairments
Open accessAbstract
Objective: To create a classification system based on stroke-related impairments. Data source: All adults with stroke admitted for at least 72 hours in England, Wales and Northern Ireland from July 2013 to July 2015 extracted from the Sentinel Stroke National Audit Programme Analysis: Impairments were defined using the National Institute of Health Stroke Scale scores at admission. Common combinations of impairments were identified based on geometric coding and expert knowledge. Validity of the classification was assessed using standard descriptive statistics to report and compare patients’ characteristics, therapy received and outcomes in each group. Results: Data from 94,905 patients were extracted. The items of the National Institute of Health Stroke Scale (on admission) were initially grouped into four body systems: Cognitive, Motor, Sensory and Consciousness. Seven common combinations of these impairments were identified (in order of stroke severity); Patients with Loss of Consciousness ( n = 6034, 6.4%); those with Motor + Cognitive + Sensory impairments ( n = 28,226, 29.7%); Motor + Cognitive impairments ( n = 16,967, 17.9%); Motor + Sensory impairments ( n = 9882, 10.4%); Motor Only impairments ( n = 20,471, 21.6%); Any Non-Motor impairments ( n = 7498, 7.9%); and No Impairments ( n = 5827, 6.1%). There was a gradation of age, premorbid disability, mortality and disability on discharge. People with the most and least severe categories were least likely to receive therapy, and received least therapy (−20 minutes/day of stay) compared to −35 minutes/day of stay for the moderately severe categories. Conclusions: A classification system of seven Stroke Impairment Categories has been presented.
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Most neurological impairments were motor (98.33%), followed by sensory (46.66%), cognitive (26.66%), and consciousness-related (6.66%), with no significant differences between groups.
“The neurological impairments related to stroke were also contemplated and classified according to a new classification system [17], which shows most of them had motor impairments (98.33%) followed by sensory impairments (46.66%), cognitive impairments (26.66%) and consciousness related impairments (6.66%), not showing significant differences between groups.”
From Early Occupational Therapy Intervention post-stroke (EOTIPS): A randomized controlled trial (2024) · cites this paper as [17]
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- Authors
- Gittins, M., Lugo-Palacios, D., Vail, A., Bowen, A., Paley, L., Bray, B., & Tyson, S.
- Affiliations
- Manchester Academic Health Science Centre (GB)
- Imperial College London (GB)
- King's College London (GB)
- The University of Queensland (AU)
- Corresponding author
- Tyson, Sarah
- ORCID
- Venue
- Clinical Rehabilitation
- Publisher
- SAGE Publications
- Published
- 2020-11-01
- Volume
- 35
- Issue
- 3
- Pages
- 446-458
- ISSN
- 0269-2155 (ISSN-L)
- 1477-0873
- PMC
- PMC7944424
- OpenAlex
- W3096007863
- Cited by
- 62
- References
- 22
- Citations by year
- 2026: 17 · 2025: 17 · 2024: 17 · 2023: 4 · 2022: 3 · 2021: 2 · 2018: 2
- FWCI
- 1.61
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- Clinical Rehabilitation (publishedVersion, cc-by-nc)
- PubMed Central (publishedVersion, cc-by-nc)
- PubMed (publishedVersion)
- Research Explorer (The University of Manchester) (publishedVersion, cc-by-nc)
- LSHTM Research Online (London School of Hygiene and Tropical Medicine) (acceptedVersion)
- Research Portal (King's College London) (submittedVersion)
- Funders
- Health Services and Delivery Research Programme (14/198/09)
- Topics
- Health Sciences › Medicine › Epidemiology › Acute Ischemic Stroke Management
- Health Sciences › Medicine › Rehabilitation › Stroke Rehabilitation and Recovery
- Health Sciences › Health Professions › Physical Therapy, Sports Therapy and Rehabilitation › Medical Practices and Rehabilitation
- Keywords
- stroke, NIHSS, motor impairment, cognitive impairment, sensory impairment, loss of consciousness, stroke severity, inpatient therapy, mortality
- MeSH terms
- Stroke Rehabilitation, Adult, Aged, Disability Evaluation, Female, United Kingdom, Hospitalization, Humans, Male, Middle Aged, Stroke, Cognitive Dysfunction
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