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Prognostic factors in the subacute phase after stroke for the future residence after six months to one year. A systematic review of the literature

D S Ihnenfeldt

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, Academic Medical Center Amsterdam, 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 a stroke for future residence at six months to one year post 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 in the field. (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 future residence; 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 10 studies involving a total of 3564 patients met the inclusion criteria. No prognostic factor was identified in at least two level A (i.e., a good level of scientific evidence according to the methodological score) studies, our standard for scientific proof. The following factors were found in at least one level A study: low initial ADL functioning, high age, cognitive disturbance, paresis of arm and leg, not alert as initial level of consciousness, old hemiplegia, homonymous hemianopia, visual extinction, constructional apraxia, no transfer to the stroke unit, nonlacunar stroke type, visuospatial construction problems, urinary incontinence and female gender.

Conclusions: At present there is insufficient evidence concerning possible predictors in the subacute stage of stroke to make an evidence-based prediction of the future residence. In the scientific research until now social factors and their contribution to the possibility of living independently have not been investigated, or at least less well. None of the studies in this review described a conceptual framework as basis for the choice of the examined prognostic factors.

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