The relation between impairments and functional outcomes poststroke

Abstract

Objective: To assess the influence of initial stroke impairments on the severity of basic and higher level functional deficits over time and to determine the cumulative impact on functional deficits beyond severity of motor deficits alone.

Design: Observational study.

Setting: Twelve participating hospitals in the Greater Kansas City area, as part of the Kansas City Stroke Study (October 1995-March 1998).

Participants: Individuals (n = 459) who sustained an eligible stroke were evaluated prospectively using standardized assessments at enrollment (within 14 days of stroke onset, 8.8 +/- 3.5 days).

Main outcome measures: Mobility and activities of daily living (ADLs) were assessed at 1, 3, and 6 months poststroke using the Functional Independence Measure, Barthel index, Lawton Instrumental Activities of Daily Living (IADL), and the Medical Outcomes Study Short-Form Health Survey instruments.

Results: The cumulative probability of achieving independence with walking, a Barthel index of 60 or greater or 90 or greater, and independence in 3 or more IADL was significantly different for the following 4 impairment groups in descending order: motor; motor and somatosensory; motor and hemianopia; and motor, sensory, and hemianopia. Although motor severity was a strong predictor of outcome (p < .0001), the additional somatosensory and hemianopia deficits significantly (p < .05) affected time and likelihood of achieving these levels of function.

Conclusion: Cumulative deficits poststroke affect patients' functional outcome in the first 6 months poststroke beyond the effect of motor severity alone.