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Prognostic factors for ambulation and activities of daily living in the subacute phase after stroke. A systematic review of the literature
R Meijer
D S Ihnenfeldt
I JM de Groot
Department of Rehabilitation Medicine, Academic Medical Center Amsterdam, The Netherlands
J van Limbeek
Department of Rehabilitation Medicine and SMK Research, Sint Maartenskliniek Nijmegen, The Netherlands
M Vermeulen
Department of Neurology, The Netherlands
R J de Haan
Department of Clinical Epidemiology and Biostatistics, Academic Medical Center Amsterdam, The Netherlands
Objective: To identify evidence-based prognostic factors in the subacute phase after stroke for activities of daily living (ADL) and ambulation at six months to one year after stroke.
Design: Systematic literature search designed in accordance with the Cochrane Collaboration criteria with the following data sources: (1) MEDLINE, EMBASE, CINAHL, Current Contents, Cochrane Database of Systematic Reviews, Psyclit, and Sociological Abstracts. (2) Reference lists, personal archives, and consultation of experts. (3) Guidelines.
Methods: Inclusion criteria were: (1) cohort studies of patients with an ischaemic or haemorrhagic stroke; (2) inception cohort with assessment of prognostic factors within the first two weeks after stroke; (3) outcome measures for ADL and ambulation; and (4) a follow-up of six months to one year. Internal, statistical and external validity of the studies were assessed using a checklist with 11 methodological criteria in accordance with the recommendations of the Cochrane Collaboration.
Results: From 1027 potentially relevant studies 26 studies involving a total of 7850 patients met the inclusion criteria. Incontinence for urine is the only prognostic factor identified in three studies with a level A (i.e., a good level of scientific evidence according to the methodological score). The following factors were found in one level A study: initial ADL disability and ambulation, high age, severe paresis or paralysis, impaired swallowing, ideomotor apraxia, ideational apraxia, and visuospatial construction problems; as well as factors relating to complications of an ischaemic stroke, such as extraparenchymal bleeding, cerebral oedema and size of intraparenchymal haemorrhage.
Conclusions: The present evidence concerning possible predictors in the subacute stage of stroke has insufficient quality to make an evidence-based prediction of ADL and ambulation after stroke because only one prognostic factor was demonstrated in at least two level A studies, our cut-off for sufficient scientific evidence.
Clinical Rehabilitation, Vol. 17, No. 2,
119-129 (2003)
DOI: 10.1191/0269215503cr585oa
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