In 1997, Duncan and coworkers [
12] compared health status of individuals with a mild stroke (n = 304) to two groups: 184 people with transient ischemic attack (TIA) and 654 people without a history of stroke/TIA but at elevated risk for stroke-asymptomatic group. The findings indicated that the consequences of a mild stroke affected all dimensions of health except pain, and that those with stroke were significantly more impaired in physical functioning, and in physical roles such as work or leisure, when compared to the other two groups. A year later, in a randomized controlled pilot study, Duncan and co-workers reported positive effects on motor function of a home-based exercise program for individuals with mild and moderate stroke [
13]. Another study from Sweden indicated that life satisfaction was significantly below norms especially satisfaction with life as a whole, sex life, and ability to manage self-care, at one-year follow-up in individuals less than 75 years of age with "mild" stroke (average Barthel Index score of 99.5/100 ± 0.5) [
1]. More recently, two qualitative studies have reported "hidden" [
14] or "invisible" [
15] consequences of stroke such as fatigue being an important source of frustration that impacts negatively on work, family, and social life. Another study led by two members of our team (AR, GB), using both quantitative and qualitative methodologies, has shown a marked decrease in participation in daily activities and social roles in individuals who sustained a "mild" stroke (n = 35) [
16]. Statistically and clinically significant restrictions in participation persisted even six months post-stroke compared to pre-stroke levels particularly related to driving, community life, leisure activities, employment, and relationships. Furthermore, more refined analyses of this sample have demonstrated that these individuals present higher risks of depressive symptoms then that of the general stroke population [
17]: in the first two weeks post-stroke, 28.6% obtained a score ≥ 10 on the Beck Depression Inventory [
18,
19],. 32.4% at three months post-stroke and 20.0% at six months post-stroke, suggesting the presence of depressive symptoms. In 2002, Martin and colleagues assessed six month outcomes including unmet needs and adherence to secondary prevention advice in a follow up study of 208 individuals with an acute stroke (87.5% of participants experienced mild stroke) [
20]. Issues raised by participants included a feeling of being abandoned by the healthcare system following hospital discharge, poor access to psychological support, lack of confidence in resuming social activities (even in those with a good physical recovery), altered role changes within the family and an intense fear of another stroke. In a review of this topic, Rodgers and coworkers [
21] concluded that affected individuals and their families had a desire for further knowledge about the causes and consequences of stroke, secondary preventative measures, and the availability of support (formal and informal) in the community.
In summary, there is the misconception that a mild stroke results in no or minimal sequelae with mounting evidence that "mild" stroke causes important consequences on all levels of health and results in the same high risk of negative events as severe stroke. This subgroup of individuals, being the most prevalent of all stroke groups, requires greater research to determine their unique needs and how those needs can be best addressed.