Late functional improvement tied to better long-term poststroke outcomes

  • Ganesh A & al.
  • J Neurol Neurosurg Psychiatry
  • 23 Jun 2020

  • curated by Sarfaroj Khan
  • UK Clinical Digest
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Takeaway

  • Late functional improvement between 3 and 12 months poststroke is associated with lower 5-year mortality, institutionalisation rates, and healthcare/social care costs.

Why this matters

  • Findings should motivate patients and physicians to maximise late recovery in routine practice, and consider access to rehabilitative services for at least 1-year poststroke.

Study design

  • This analysis of the prospective, population-based Oxford Vascular study (OXVASC) included 1288 one-year ischaemic stroke survivors between 2002 and 2014.
  • Changes in functional status (modified Rankin Scale [mRS], Rivermead Mobility Index [RMI], Barthel Index [BI]) from 3 to 12 months poststroke were evaluated.
  • Funding: Wellcome Trust and others.

Key results

  • A total of 1135 (88.1%) one-year survivors had 3-month mRS >0, of whom 319 (28.1%) showed late functional improvement between 3 and 12 months poststroke.
  • Late improvement was associated with lower 5-year:
    • mortality (adjusted HR [aHR] per mRS, 0.68; 95% CI, 0.51-0.91; P=.009);
    • institutionalisation (aHR; 95% CI, 0.33-0.72; P<.001 and>
    • healthcare/social care costs (margin: US$ −17,369; 95% CI, −25,271 to −9469; P<.001>
  • After excluding patients with recurrent strokes during follow-up, these associations remained significant for 5-year:
    • mortality/institutionalisation (aHR, 0.59; 95% CI, 0.44-0.79; P<.001>
    • mortality/institutionalisation with RMI/BI (aHR, 0.73; 95% CI, 0.58-0.92; P=.008); and
    • healthcare/social care costs (US$−17,283; 95% CI, −25,594 to −8972; P<.001>

Limitations

  • Analyses could not account for the added costs per unit of improvement that would be incurred through interventions beyond standard care.
  • Scales like the mRS can be confounded by non-stroke-related disability and have inter-rater variability.