Prediction of long-term functional outcome after stroke rehabilitation

Abstract

Objective: To find patient characteristics in the early post stroke phase that could predict three years functional outcome.

Design: Prospective study.

Setting: In-hospital rehabilitation department (admission and discharge). Outpatient department one and three years post stroke.

Subjects: One hundred and forty-two stroke patients (56% women), median age 75 years.

Main outcome measures: Barthel Index (BI) score; BI score change; accommodation status; Rankin scale score; and Frenchay Activities Index (FAI) score, all registered three years post stroke.

Results: The percentages of patients still living at home after one and three years were 88% and 83%, respectively. Twenty per cent of the patients had deteriorated according to the BI after three years, mostly due to recurrent strokes (odds ratio (OR) 10.3; 95% confidence interval (CI) 3.0-35.5) and co-morbidity with other disabling disorders (OR 3.9; CI 1.1-13.5). Co-morbidity also emerged as an important risk factor for dependency according to BI score (OR 8.8; Cl 2.4-32.1) as well as for a poor FAI score (OR 4.9; CI 1.9-13.0). BI in the early phase was the strongest predictor for long-term functional outcome. Urinary incontinence emerged as a risk factor for nursing home placement after three years (OR 3.2; CI 0.9-11.3). Cognitive dysfunction was a risk factor for poor FAI scoring (OR 2.7; CI 1.0-7.0).

Conclusions: After stroke rehabilitation, concomitant chronic disabling disorders and recurrent strokes seem to play an important role regarding dependency, handicap and long-term functional decline.