Takeaway
- Patients with lacunar strokes have a significantly greater potential for late functional improvement from 3 to 12 months.
- This finding should motivate patients and clinicians to maximise late improvements in routine practice.
Why this matters
- This finding has clinical implications for motivating and rehabilitating patients with lacunar stroke in routine practice, for the design of restorative therapy trials and for understanding of functional recovery.
Study design
- Prospective, population-based cohort study of 3-month ischaemic stroke survivors (n=1425; Oxford Vascular Study; 2002–2014).
- Functional improvement was assessed by using modified Rankin Scale (mRS), Rivermead Mobility Index (RMI), Barthel Index in patients with lacunar (n=234) vs nonlacunar ischaemic strokes (n=1191) from 3 to 60 months poststroke.
- Funding: Wellcome Trust, Wolfson Foundation, and National Institute for Health Research Oxford Biomedical Research Centre.
Key results
- After adjustment for confounders, no significant difference was found in 3-month mRS >2 between patients with lacunar stroke vs nonlacunar stroke (aOR, 1.14; P=.55).
- Patients with lacunar stroke were more likely to demonstrate improvement in mRS between 3 and 12 months poststroke vs nonlacunar stroke (aOR, 1.64; P=.004).
- Similar results were seen in patients with 3-month mRS 2–4 and those excluding recurrent events (aOR, 2.28; P=.002).
- Patients with lacunar stroke had RMI improvement between 3 months and 1 year vs nonlacunar stroke (aOR, 1.78; P=.004).
Limitations
- Neurological impairments were not serially determined using measures like the National Institutes of Health Stroke Scale or Fugl-Meyer Scale.
- Scales like the mRS can be confounded by non-stroke-related disability.
References
References
