Is Sex a Prognostic Factor in Stroke Rehabilitation?

Paolucci, Stefano; Bragoni, Maura; Coiro, Paola; Angelis, Domenico De; Fusco, Francesca R.; Morelli, Daniela; Venturiero, Vincenzo; Pratesi, Luca

doi:10.1161/01.str.0000248456.41647.3d

Cited by 118 publications

(113 citation statements)

References 32 publications

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“…A basic question, especially concerning age, is whether the apparent associations are due to ageing itself or secondary to other causes. Regarding sex, previous researchers have generally reported a negative effect of female sex on functional outcome 5, 19, 20, 21, 22, 23, 24, 25, 26, 27. This is seen also in the present study (for details, see11).…”

Section: Discussionsupporting

confidence: 86%

“…This has been demonstrated universally and it is also a main finding in our study. In addition higher age,3, 5, 8, 9 female sex,5, 19, 21, 22, 23, 24, 25, 26, 27 prior cerebrovascular disease,3, 5, 8 peripheral artery disease,7 arm paresis,5 diabetes,5, 7 fever,5 TOAST‐classification 4, 28 and infarct location,5, 6, 28 among others, have been reported to be negative predictors. The main results in our study thus are consistent with previous findings, emphasising especially stroke severity and prior cerebrovascular disease in addition to age and sex.…”

Section: Discussionmentioning

confidence: 99%

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Subjective health complaints predict functional outcome six months after stroke

et al. 2016

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ObjectivesCerebrovascular stroke is a main cause of lasting disability in older age, and initial stroke severity has been established as a main determinant for the degree of functional loss. In this study, we searched for other predictors of functional outcome in a cohort of stroke patients participating in an early supported discharge randomised controlled trial.MethodsThirty candidate variables related either to premorbid history or to the acute stroke were examined by ordered logistic regression in 229 stroke patients. Dependent variables were modified Rankin Scale (mRS) at 6 months and mRS change from baseline to 6 months.ResultsFor mRS at 6 months, Barthel Index at stable baseline post‐stroke was the main predictor, with sex, age, previous cerebrovascular disease, previous peripheral artery disease and the necessity for tube feeding in the acute phase also contributing to the final model. For mRS change, only age and previous cerebrovascular disease were significant predictors. Prestroke subjective health complaints added significantly to all final models concurrently with sex losing its predictive power.ConclusionsInitial stroke severity was the main predictor of functional outcome. Subjective health complaints score was a potent predictor for both outcome and improvement from baseline to 6 months and at the same time ameliorated the predictive impact of sex. The poorer functional prognosis for women after stroke may therefore be related to their higher load of subjective health complaints rather than to their sex itself. Treating these complaints may possibly improve the functional prognosis.

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Section: Discussionsupporting

confidence: 86%

Section: Discussionmentioning

confidence: 99%

Subjective health complaints predict functional outcome six months after stroke

et al. 2016

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“…Male gender has also been previously reported to have a three fold impact on recovery of ADL skills, which was thought to be associated with the greater strength levels in men or the increased willingness of women to solicit help. 40 Clearly, the role of concordance and gender on quality of life activities bears further scrutiny.…”

Section: Discussionmentioning

confidence: 99%

Retention of upper limb function in stroke survivors who have received constraint-induced movement therapy: the EXCITE randomised trial

Wolf

Winstein

Miller

et al. 2008

The Lancet Neurology

294

166

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SummaryBackground-Constraint-Induced Movement therapy (CIMT) uses a variety of treatment components, including restricted use of the better upper extremity, to promote increased use of the contralesional limb for many hours each weekday over two consecutive weeks. The EXCITE Trial demonstrated the efficacy of this intervention for patients 3-9 months post-stroke who were followed for the next 12 months. We assessed the retention of improvements through 24 months.

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“…5 One possible explanation for the difference in mobility and functional ADL may be that women may have more limitations in muscle function that affect physical recovery, as shown in a rehabilitation cohort matched for stroke severity between women and men. 32 Given the significance of 3-month disability on 12-month EQ-5D in the current analysis, the reduced ability of women to recover physically may be an important driver of the differences in longer-term QOL. The reasons for pain or discomfort dimension of the EQ-5D were not ascertained, but could be attributable to stroke-or nonstroke-related conditions.…”

Section: 35-710-14mentioning

confidence: 96%

Sex differences in quality of life after ischemic stroke

et al. 2014

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Objective: We aimed to compare quality of life (QOL) in women and men after ischemic stroke or TIA, and to determine the incremental impact of demographic, socioeconomic, clinical, and stroke-specific effects on longitudinal QOL. Methods:We assessed QOL in patients with ischemic stroke or TIA at 3 and 12 months postdischarge in the Adherence eValuation After Ischemic stroke-Longitudinal Registry using the European Quality of Life-5 Dimensions (EQ-5D) instrument. We generated multivariable linear regression models to evaluate the association between sex and EQ-5D while sequentially adjusting for sociodemographic, clinical, and stroke-related variables. We also used a proportional odds model to assess sex differences in the change in EQ-5D scores from 3 to 12 months.Results: A total of 1,370 patients were included, 53.7% male, median age 65 years (interquartile range 56-77 years). Women had significantly lower QOL at 3 months (unadjusted EQ-5D 0.81 in women vs 0.84 in men; p , 0.001) and 12 months (0.83 vs men 0.84; p , 0.001) poststroke. After multivariable adjustment for sociodemographic, clinical, and stroke-related factors, women continued to have lower QOL at 3 months (mean difference 20.036; p 5 0.003) and at 12 months (mean difference 20.022; p 5 0.046). Women fared worse in the dimensions of mobility, pain/ discomfort, and anxiety/depression at 3 and 12 months. There were no sex differences in change in EQ-5D score from 3 to 12 months. Conclusion:Women have worse QOL than men up to 12 months after stroke, even after adjusting for important sociodemographic variables, stroke severity, and disability. Neurology ® 2014;82:922-931 GLOSSARY ADL 5 activities of daily living; AVAIL 5 Adherence eValuation After Ischemic stroke-Longitudinal; CI 5 confidence interval; EQ-5D 5 European Quality of Life-5 Dimensions; GWTG-Stroke 5 Get With The Guidelines-Stroke; mRS 5 modified Rankin Scale; NIHSS 5 NIH Stroke Scale; OR 5 odds ratio; QOL 5 quality of life.Because stroke has dropped from the third to the fourth leading cause of death, 1 increasing attention should be given to improving quality of life (QOL) for stroke survivors. Several patient factors, including age, socioeconomic status, stroke severity, mood, and sex (particularly societal roles), may influence QOL after stroke.2-4 Multiple studies, 5-14 but not all, [15][16][17][18] have shown that women have worse QOL after stroke than men, particularly in the domains of mental and physical function. 5,6,10,14 The timing and longitudinal assessment of QOL may be important, as sex differences may be greater early after stroke, then diminish over the long term with rehabilitation and recovery. 19 Whether there are truly differences in QOL for men and women independent of these factors is uncertain.Our aims in this analysis were to (1) compare QOL in men and women at 3 and 12 months, (2) compare the change in QOL over time between men and women, and (3) determine the incremental impact of demographic, socioeconomic, clinical, and stroke-specific effects on long...

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Is Sex a Prognostic Factor in Stroke Rehabilitation?

Cited by 118 publications

References 32 publications

Subjective health complaints predict functional outcome six months after stroke

Subjective health complaints predict functional outcome six months after stroke

Retention of upper limb function in stroke survivors who have received constraint-induced movement therapy: the EXCITE randomised trial

Sex differences in quality of life after ischemic stroke

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