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Recovery, Functional Status, and Health-Related Quality of Life Status up to 4 Years after First-Ever Stroke Onset : A Population-Based Study

Aked, Joseph LU orcid ; Delavaran, Hossein LU ; Wennerström, Fredrik and Lindgren, Arne G. LU (2024) In Neuroepidemiology
Abstract

Background: Stroke is a leading cause of acquired disability in adults worldwide, and the burden of stroke is projected to increase. Current long-term stroke outcome data including functional status, activity, and participation limitations as well as information on health-related quality of life (HRQoL) are vital for future rehabilitation and resource planning of stroke survivors. Methods: First-ever stroke survivors from a population-based cohort with ischemic stroke or intracerebral hemorrhage were followed up 3.4 years after stroke onset via clinic appointments, home visits, or telephone. Ischemic stroke was stratified by clinical syndrome (Oxfordshire Community Stroke Project classification) and pathogenetic mechanism (TOAST... (More)

Background: Stroke is a leading cause of acquired disability in adults worldwide, and the burden of stroke is projected to increase. Current long-term stroke outcome data including functional status, activity, and participation limitations as well as information on health-related quality of life (HRQoL) are vital for future rehabilitation and resource planning of stroke survivors. Methods: First-ever stroke survivors from a population-based cohort with ischemic stroke or intracerebral hemorrhage were followed up 3.4 years after stroke onset via clinic appointments, home visits, or telephone. Ischemic stroke was stratified by clinical syndrome (Oxfordshire Community Stroke Project classification) and pathogenetic mechanism (TOAST classification). We assessed the participants f functional status and independence with the modified Rankin Scale (mRS) and Barthel Index (BI) and their HRQoL across several domains (Short Form Questionnaire-36, EuroQoL-5D, and Stroke Impact Scale (SIS)). We used logistic and linear regression analyses to analyze potential baseline predictors of 3.4-year outcome. Results: Four hundred individuals were included; 151 died before clinical follow-up and 47 (12%) were lost to detailed follow-up. Two hundred and two individuals (median age: 72, IQR: 65.79; 40% female) were followed up after a median of 3.2 years (IQR: 3.1.3.5). Nineteen individuals (9%) had a recurrent stroke during the 3.4-year follow-up period. Among the 202 follow-up attendees, 147 (73%) had favorable functional outcome (mRS .2) and 134 (69%) of the 195 respondents reported good-excellent HRQoL according to SF-36. Age (HR: 1.03; 95% CI: 1.00.1.05), initial stroke severity (HR: 1.16; 95% CI: 1.10.1.22; p < 0.001), living with inhome care or in care facility at baseline (HR: 8.77; 95% CI: 2.98.25.64), and recurrent stroke (HR: 3.58; 95% CI: 1.47.8.77) were predictors of poor functional outcome (mRS>2). Poor functional outcome/death was less common among IS due to Other Causes and Small Artery Occlusion than other pathogenetic mechanisms (20% and 33% vs. 56.68%; p < 0.01). SIS respondents with poor functional outcomes (n = 32) reported worst outcome in the hand domain of SIS (median: 28/100; IQR: 0.73). Conclusions: Most 3.4-year stroke survivors have favorable functional outcomes and are independent in ADL in a population- based cohort. Despite its relative rarity, recurrent stroke was a predictor of poor functional outcome, emphasizing the need of adequate secondary prevention.

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author
; ; and
organization
publishing date
type
Contribution to journal
publication status
in press
subject
keywords
Activities of daily living, Health-related quality of life, Outcome, Stroke
in
Neuroepidemiology
publisher
Karger
external identifiers
  • pmid:38531332
  • scopus:85196156968
ISSN
0251-5350
DOI
10.1159/000538222
language
English
LU publication?
yes
id
052fcaa7-11fa-448f-b28f-9f82ae2b88e8
date added to LUP
2024-09-11 14:52:50
date last changed
2024-09-11 14:53:49
@article{052fcaa7-11fa-448f-b28f-9f82ae2b88e8,
  abstract     = {{<p>Background: Stroke is a leading cause of acquired disability in adults worldwide, and the burden of stroke is projected to increase. Current long-term stroke outcome data including functional status, activity, and participation limitations as well as information on health-related quality of life (HRQoL) are vital for future rehabilitation and resource planning of stroke survivors. Methods: First-ever stroke survivors from a population-based cohort with ischemic stroke or intracerebral hemorrhage were followed up 3.4 years after stroke onset via clinic appointments, home visits, or telephone. Ischemic stroke was stratified by clinical syndrome (Oxfordshire Community Stroke Project classification) and pathogenetic mechanism (TOAST classification). We assessed the participants f functional status and independence with the modified Rankin Scale (mRS) and Barthel Index (BI) and their HRQoL across several domains (Short Form Questionnaire-36, EuroQoL-5D, and Stroke Impact Scale (SIS)). We used logistic and linear regression analyses to analyze potential baseline predictors of 3.4-year outcome. Results: Four hundred individuals were included; 151 died before clinical follow-up and 47 (12%) were lost to detailed follow-up. Two hundred and two individuals (median age: 72, IQR: 65.79; 40% female) were followed up after a median of 3.2 years (IQR: 3.1.3.5). Nineteen individuals (9%) had a recurrent stroke during the 3.4-year follow-up period. Among the 202 follow-up attendees, 147 (73%) had favorable functional outcome (mRS .2) and 134 (69%) of the 195 respondents reported good-excellent HRQoL according to SF-36. Age (HR: 1.03; 95% CI: 1.00.1.05), initial stroke severity (HR: 1.16; 95% CI: 1.10.1.22; p &lt; 0.001), living with inhome care or in care facility at baseline (HR: 8.77; 95% CI: 2.98.25.64), and recurrent stroke (HR: 3.58; 95% CI: 1.47.8.77) were predictors of poor functional outcome (mRS&gt;2). Poor functional outcome/death was less common among IS due to Other Causes and Small Artery Occlusion than other pathogenetic mechanisms (20% and 33% vs. 56.68%; p &lt; 0.01). SIS respondents with poor functional outcomes (n = 32) reported worst outcome in the hand domain of SIS (median: 28/100; IQR: 0.73). Conclusions: Most 3.4-year stroke survivors have favorable functional outcomes and are independent in ADL in a population- based cohort. Despite its relative rarity, recurrent stroke was a predictor of poor functional outcome, emphasizing the need of adequate secondary prevention.</p>}},
  author       = {{Aked, Joseph and Delavaran, Hossein and Wennerström, Fredrik and Lindgren, Arne G.}},
  issn         = {{0251-5350}},
  keywords     = {{Activities of daily living; Health-related quality of life; Outcome; Stroke}},
  language     = {{eng}},
  publisher    = {{Karger}},
  series       = {{Neuroepidemiology}},
  title        = {{Recovery, Functional Status, and Health-Related Quality of Life Status up to 4 Years after First-Ever Stroke Onset : A Population-Based Study}},
  url          = {{http://dx.doi.org/10.1159/000538222}},
  doi          = {{10.1159/000538222}},
  year         = {{2024}},
}