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Prediction of long-term functional outcome after stroke rehabilitation

Department of Geriatrics and Rehabilitation, Aker Hospital, Oslo, Norway

Trond Dahl

Department of Cardiology, Aker Hospital, Oslo, Norway

Torgeir Bruun Wyller

Department of Geriatric Medicine, Ullevål Hospital and Department of Geriatrics and Rehabilitation, Aker Hospital, Oslo, Norway

Objective: To "nd 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% con"dence 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; CI 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.

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