Handicap and Its Determinants of Change in Stroke Survivors

Abstract

Background and Purpose-Stroke, a major health issue affecting the elderly, limits their participation in society. The aim of this study was to investigate changes in stroke survivors' handicap levels and to identify their determinants in the subacute phase from 3 months to 1 year. Methods-Data were collected from a prospective cohort of 303 Chinese stroke survivors with the use of questionnaires, including the Lawton Instrumental Activities of Daily Living-Chinese Version (IADL-CV), Barthel Index, Chinese Mini-Mental State Examination, Chinese Geriatric Depression Scale, and the Chinese version of the London Handicap Scale. Results-A total of 297 and 268 patients were successfully followed up at 6 and 12 months, respectively. Whereas IADL remained unchanged throughout, we found an improvement in Barthel Index but a deterioration in the Chinese Geriatric Depression Scale score at 12 months. Multilevel modeling revealed improvements in the mobility and social integration handicap domains and a deterioration in the orientation domain at 12 months. Overall handicap remained unchanged. At 12 months, depression was most significantly and independently associated with poststroke handicap, and advanced old age alone (Ͼ80 years) was associated with clinically significant deterioration in handicap. Conclusions-Even though IADL remained static at 1 year, mobility and social integration handicap dimensions can be improved in the early community phase after stroke. Nonphysical factors such as depression were confirmed to be significantly associated with handicap. Rehabilitation should target the high-risk group of very elderly stroke survivors who were 4 times more likely to deteriorate in handicap. (Stroke. 2008;39:148-153.)

Longitudinal Analysis of Quality of Life for Stroke Survivors Using Latent Curve Models

“…Handicap is also associated with mood. 10 How handicap is perceived and reported may therefore be influenced by mood. Probably because of The strength of this study is the statistical model, which helped to delineate the relative contribution of functional status, handicap, and depression in the HRQOL of patients with stroke in a prospective manner.…”

“…9 In the same study, it was observed that ADL, including instrumental ADL, remained stable, whereas occupation and orientation domains of handicap and depression deteriorated. 10 These changes are indicative of the dynamic nature of psychosocial adjustment or maladjustment after stroke. To understand the relative importance of these interrelated factors in determining HRQOL in the first year after stroke, we constructed a dynamic latent curve model to study how the changes in HRQOL relate to the changes in ADL, handicap, and depression.…”

Sex Differences in Long-Term Outcomes After Stroke

“…Four of 5 studies used the London Handicap Scale, which is validated for use in stroke. 41 Further details of the included studies are given in online-only Data Supplement Figure II and online-only Data Supplement Table II. Most authors reported that females had more handicap than males in univariable analyses 11,[37][38][39] with only 1 study 40 failing to find a sex difference. In general, sex did not independently predict overall handicap scores when adjusted for other factors such as age, poststroke disability, and mood.…”

“…Feigin et al 11 reported that females were more restricted than males in mobility, physical independence, and occupation/leisure domains of the London Handicap Scale but less restricted in terms of economic self-sufficiency. Lo et al 40 reported that, despite no difference in overall handicap, females had greater physical independence handicap than males after adjustment for age, dependence in ADL, and financial assistance. The authors did not present disaggregated results, so it is unknown if sex differences in other domains of handicap were found.…”

The depressive disorders during the early rehabilitation period following preceding ischemic stroke: the possibilities for the application of the enhanced external counterpulsation method

“…У больных с постинсультной депрессией от-мечено увеличение риска смертности, менее выра-женное восстановление нарушенных когнитивных и неврологических функций, увеличение продол-жительности восстановительного периода, более значимые нарушения активности в повседневной жизни, снижение качества жизни и приверженно-сти рекомендованной терапии [12,13].…”