Early Prediction of Outcome of Activities of Daily Living After Stroke

Abstract

Background and Purpose-Knowledge about robust and unbiased factors that predict outcome of activities of daily living (ADL) is paramount in stroke management. This review investigates the methodological quality of prognostic studies in the early poststroke phase for final ADL to identify variables that are predictive or not predictive for outcome of ADL after stroke. Methods-PubMed, Ebsco/Cinahl and Embase were systematically searched for prognostic studies in which stroke patients were included Յ2 weeks after onset and final outcome of ADL was determined Ն3 months poststroke. Risk of bias scores were used to distinguish high-and low-quality studies and a qualitative synthesis was performed. Results-Forty-eight of 8425 identified citations were included. The median risk of bias score was 17 out of 27 (range, 6 -22) points. Most studies failed to report medical treatment applied, management of missing data, rationale for candidate determinants and outcome cut-offs, results of univariable analysis, and validation and performance of the model, making the predictive value of most determinants indistinct. Six high-quality studies showed strong evidence for baseline neurological status, upper limb paresis, and age as predictors for outcome of ADL. Gender and risk factors such as atrial fibrillation were unrelated to this outcome. Conclusions-Because of insufficient methodological quality of most prognostic studies, the predictive value of many clinical determinants for outcome of ADL remains unclear. Future cohort studies should focus on early prediction using simple models with good clinical performance to enhance application in stroke management and research. (Stroke.

PREP2: A biomarker‐based algorithm for predicting upper limb function after stroke

“…Age binarized at 80 years is a new predictor identified by the CART analysis. The finding that patients aged 80 years or more needed to be less impaired (SAFE score ≥ 8) in order to achieve the same functional outcome as their younger counterparts is in keeping with previous reports that age is an independent predictor of stroke outcome 2, 20. TMS is only required for patients with a SAFE score less than 5.…”

“…Previous studies have used clinical measures alone to predict upper limb outcomes 2, 3, 4. One study found that patients at 48 h poststroke with a Fugl‐Meyer scale score of at least 1 point for paretic finger extension, and a Motricity Index score of at least 9 points for shoulder abduction, had a 98% probability of having “manual dexterity” 6 months poststroke, defined as an ARAT score of at least 10 points 23.…”

“…Recovery of upper limb motor function is important for regaining independence after stroke 1, 2. In general, greater initial impairment is associated with worse motor outcomes 2, 3.…”

“…In general, greater initial impairment is associated with worse motor outcomes 2, 3. However, experienced clinicians find it difficult to accurately predict functional outcomes for individual patients 4.…”

Recovery of ambulation activity across the first six months post-stroke

“…Models were adjusted for age and discharge gait speed. Age has been recognised as a significant predictor of functional recovery 22 , and gait speed is a predictor of free-living activity in people with chronic stroke 23 . Significance was set at p < 0.05 and SPSS 21.0 was used for all statistical calculations.…”