Changes in functional outcome over five years after stroke

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.

Self-rated health over the first five years after stroke

“…Data were obtained from two quality registers assessing stroke care; the Swedish Stroke Register [ 15 ], the Skaraborg Longitudinal Stroke Register (SLAG) and the Swedish population registry. The SLAG register has been described in detail elsewhere [ 16 ]. In short, SLAG is a local register complementing the Swedish Stroke Register containing data from a postal questionnaire distributed annually over 5 years to all surviving stroke patients admitted to the Stroke Units at the Skaraborg Hospitals from 1 January 2007 to 31 December 2009.…”

Outcomes within a year following first ever stroke in Tanzania

“…Globally stroke led to 116.4 million disability adjusted life years (DALYs) in the year 2016 [1]. The risk for disability after a first stroke in Europe is estimated to be 20% [12] whereas for Tanzania, post stroke severe disability was 56% and 49% for ischemic and hemorrhagic stroke respectively [11]. Prompt and effective management of hypertension, diabetes and thrombosis reduce the risk of stroke recurrence while rehabilitation reduces disability [13].…”

Investigating predictors of community integration in individuals after stroke in a residential setting: A longitutinal study

“…The persistent side effects caused by stroke lead to relevant limitations in activities, generating a reduced perception of well-being in affected individuals [2,4]. A significant proportion of survivors persist with moderate or severe disability [5,6], which interferes in their return to activities and previous lifestyles, thereby hindering the social integration of these individuals within their communities [2,7]. Studies indicate that affected individuals suffer social isolation, restricted social participation and difficulties in reintegration [8,9].…”