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. 2019 Jun;9(6):e01300.
doi: 10.1002/brb3.1300. Epub 2019 May 7.

Changes in functional outcome over five years after stroke

Åsa Rejnö  1   2 , Salmir Nasic  3 , Kerstin Bjälkefur  4 , Eric Bertholds  1 , Katarina Jood  5
Affiliations

Changes in functional outcome over five years after stroke

Åsa Rejnö et al. Brain Behav. 2019 Jun.

Abstract

Objectives: Data on the long-term time course of poststroke functional outcome is limited. We investigated changes in functional outcome over 5 years after stroke in a hospital based cohort.

Materials and methods: Consecutive patients who were independent in activities of daily living (ADL) and admitted to a Stroke Unit at Skaraborg Hospital, Sweden for a first acute stroke from 2007 to 2009 (n = 1,421) were followed-up after 3 months and thereafter annually over 5 years using a postal questionnaire. Clinical variables at acute stroke and 3 months post stroke were obtained from the Swedish Stroke Register. ADL dependency was defined as dependence in dressing, toileting or indoor mobility.

Results: The proportions of survivors who reported ADL dependency remained stable throughout follow-up (19%-22%). However, among survivors who were ADL independent at 3 months, about 3% deteriorated to dependency each year. Deterioration was predicted by age (HR 1.11; 95% CI 1.08-1.13), diabetes (HR 1.65; 95% CI 1.12-2.44), NIHSS score (HR 1.07; 95% CI 1.04-1.10), and self-perceived unmet care needs one year post stroke (HR 2.01; 95% CI 1.44-2.81). Transitions from ADL dependency to independence occurred mainly during the first year post stroke. Improvement was negatively predicted by living alone before stroke (HR 0.41 95% CI 0.19-0.91), NIHSS score (HR 0.90; 95% CI 0.86-0.95) and ischemic stroke (vs. hemorrhagic stroke), HR 0.39; 95% CI 0.17-0.89.

Conclusion: Transitions between ADL independence and dependency occur up to 5 years after stroke. Some of the factors predicting these transitions are potentially modifiable.

Keywords: functional outcome; longitudinal study; quality register; stroke.

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Conflict of interest statement

The Authors declare that there is no conflict of interest.

Figures

Figure 1
Figure 1
Study flowchart
Figure 2
Figure 2
Outcomes at follow‐up with respect to death and dependence/independence in activities of daily living
Figure 3
Figure 3
Time to activity in daily life (ADL) dependency (deterioration, a) and ADL independency (improvement, b) according to age, in survivors ADL independent at 3 months (n = 908) (a) and in survivors ADL dependent at 3 months (n = 272) (b)
See this image and copyright information in PMC

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