Patient-reported outcomes after stroke in young adults: University College London (UCL) Young Stroke Systematic Evaluation Study (ULYSSES).

BACKGROUND

Few studies have investigated patient-reported non-motor outcomes after stroke in young adults. We aimed to assess their prevalence and patterns in this population to identify unmet needs.

METHODS

This prospective cohort study included consecutive patients (aged <55) admitted to University College London (UCL) Hospitals Hyperacute Stroke Unit with ischaemic stroke or intracerebral haemorrhage (ICH) between 2017 and 2020. At 6 months, we collected data on eight non-motor domains (anxiety, depression, fatigue, sleep disturbance, pain interference, reduced social participation, bowel and bladder dysfunction). We assessed outcome co-occurrence, compared prevalence by modified Rankin Scale (mRS) score (favourable: 0-1 versus unfavourable: 2-5), and performed multivariable logistic regression to identify predictors of each adverse outcome and high non-motor outcome burden (≥3 adverse outcomes).

RESULTS

We included 493/527 (94%) eligible patients (median age 48, IQR 41-52; 33% female; 82% ischaemic stroke). Fatigue (55%) reduced social participation (47%) and sleep disturbance (46%) were most common. Prevalence rates did not differ significantly by mRS score. 91% reported ≥1 adverse outcome; 27% reported ≥4. Anxiety was predicted by ICH (OR 1.92; 95% CI 1.11 to 3.33; p=0.019) and higher education levels (per decile increase in education deprivation, OR 1.12; 95% CI 1.03 to 1.22; p=0.012). Pain interference was predicted by admission stroke severity (per National Institutes of Health Stroke Scale 10-point increase, OR 1.54; 95% CI 1.05 to 2.25; p=0.025).

CONCLUSIONS

Adverse non-motor outcomes are common in young adults 6 months post-stroke, even in those with an mRS score of 0-1 (indicating a favourable functional recovery). Furthermore, non-motor outcomes rarely occur in isolation, highlighting the need for early and comprehensive screening, recognition and management.