Association between activities of daily living independence and observational attention ratings in patients with acute stroke

OBJECTIVE: As neuropsychological tests insufficiently reflect impairments in activities of daily living (ADL), behavioral observation using Moss Attention Rating Scale (MARS) is necessary. Although MARS scores are associated with ADL independence, their longitudinal relationship remains unclear. This study aimed to investigate whether changes in MARS scores over time are associated with ADL independence in patients with mild-to-moderate acute stroke who could undergo neuropsychological tests. METHODS: This single-center, prospective longitudinal cohort study included 60 patients (median age: 73.5 years) hospitalized for acute stroke for ≥14 days. The median interval from stroke onset to initial evaluation was 3 days. The primary outcome was ADL independence, measured using the Barthel Index (BI) at 2 weeks. RESULTS: Multiple regression analysis identified MARS as a significant predictor of BI at 2 weeks. Neuropsychological tests revealed floor effects, whereas MARS did not. Receiver operating characteristic curves demonstrated strong discriminative ability of MARS for predicting BI ≥ 60 (area under the curve: 0.96 [baseline], 0.93 [1 week]). CONCLUSIONS: MARS is more effective than conventional neuropsychological tests for assessing attention-related ADL independence, particularly in early stroke rehabilitation. CLINICAL TRIAL REGISTRATION: UMIN000055922.