- 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.
- 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.
- 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>
- 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>
- 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.