The Pediatric Stroke Recurrence and Recovery Questionnaire: validation in a prospective cohort

Abstract

Objective: We developed the Recurrence and Recovery Questionnaire (RRQ) by converting the Pediatric Stroke Outcome Measure (PSOM) to a questionnaire for telephone interview and sought to validate the RRQ in a large cohort.

Method: We analyzed parents' RRQ responses and same-day PSOM assessments for 232 children who had arterial ischemic stroke, cerebral sinovenous thrombosis, or presumed perinatal ischemic stroke. We assessed the agreement and consistency of the PSOM and RRQ, and we identified conditions that contributed to differences between the 2 measures. We tested selected factors as predictors of differences between the total PSOM and total RRQ (tPSOM and tRRQ) scores.

Results: Median PSOM score was 1.5 and median RRQ score was 1.5. There was good agreement between tPSOM and tRRQ, and RRQ was a reliable estimator of PSOM at the total and component level. Preexisting neurologic deficits or chronic illnesses increased the difference between the tPSOM and tRRQ; the chronic illness effect was confirmed with univariate analysis.

Conclusions: The RRQ can characterize poststroke function when a child cannot return for examination. While the RRQ is not identical to the PSOM, the 2 measures likely assess closely related aspects of recovery. The RRQ is particularly useful when assessing outcomes of large cohorts, and will be useful in performing long-term follow-up studies of pediatric stroke.

Figures

Figure 1. A Bland-Altman plot demonstrates agreement between Recurrence and Recovery Questionnaire total score (tRRQ) and Pediatric Stroke Outcome Measure total score (tPSOM)

The mean of the tPSOM and RRQ scores is plotted on the X-axis while the difference between tPSOM and tRRQ (tPSOM-tRRQ) is plotted on the Y-axis. The overlying circles represent multiple subjects per data point. The solid line identifies the mean value. The dashed lines identify ± 2 SD. No. = 232.

Figure 2. Frequency plots for Pediatric Stroke Outcome Measure total score (tPSOM)–Recurrence and Recovery Questionnaire total score (tRRQ)

Note the different ranges on the respective Y axes. The smooth line represents the hypothetical normal distribution. (A) All cases. Mean 0.36, SD 1.453, n = 232. (B) Cases with preexisting neurologic deficits or chronic illness. Mean 0.86, SD 1.529, n = 76. (C) Cases without preexisting conditions. Mean 0.12, SD 1.355, n = 156.

Figure 3. Scatterplot and linear regression of Recurrence and Recovery Questionnaire total score (tRRQ) vs Pediatric Stroke Outcome Measure total score (tPSOM)

The overlying circles represent multiple subjects per data point. The dashed line is the line of identity. The solid line is the regression line fitting the data. tPSOM = (0.90 × tRRQ) + 0.55, R2 = 0.61, p < 0.001.