Stroke: good clinical function increases the chance of independence.

Clinical bottom line (level 2c)

  1. Nearly a half of patients who had a disabling stroke returned to independence.
  2. Patients who had a disabling stroke were more likely to return to independence within 4 weeks if they had no or slight weakness in upper limb motor function; no or slight difficulty with proprioception; walking or standing as postural function.
Prescott et al: Stroke 1982; 13 (5): 641-647
Expires December 2002

The study

Retrospective cohort study with objective outcomes, adjusted for confounding factors, not validated in an independent set of patients.

Setting: 12 medical centres and a stroke unit, UK

149 patients (aged range 60 to 91 years; mean 73, 53% female) acute stroke and randomised to rehabilitation in previous trial

Excluded if
  • unconscious at onset of stroke
  • previously dependent in daily activities
  • able to walk without assistance after stroke
  • no demonstrable hemiplegia




    • followed for 16 weeks
    Outcomes studied:
  • return to independence

    • The evidence

    outcome time to outcome number of patients/total number %
    (95% CI)
    return to independence 16 weeks 44/100 44.0%
    (34.3% to 53.7%)

    prognostic factor for
    return to independence     		time to outcome unadjusted RR
    (95% CI)    		 NNF+
    (95% CI)
    no or slight weakness in upper limb motor function 16 weeks 2.33
    (1.52 to 3.56)     		2
    (1 to 6)
    no or slight difficulty with proprioception 16 weeks 2.56
    (1.43 to 4.60)     		3
    (1 to 10)
    walking or standing (postural function) 16 weeks 2.69
    (1.61 to 4.50)     		2
    (1 to 7)

    • Loss of memory recall, difficulty with problem solving, lower limb motor function, comprehension, ability to express oneself and normal or abnormal hand on 2 point discrimination were also analysed, but these were not as predictive of return to independence.

    Comments

    1. Data was taken from a randomised controlled trial.
    2. Only patients who were rehabilitated in the stroke unit were used to determine the predictive value of weekly clinical tests (n=155).

    Citation

    1. Prescott RJ, Garraway WM, Akhtar AJ: Predicting functional outcome following acute stroke using a standard clinical examination. Stroke 1982; 13 (5): 641-647
    Contributor: Clare Wotton & Lee Bailey, December 1999
    Reviewer: Graeme Hankey

    Clinical Question.
    Patient acute stroke
    Intervention or Exposure good results in weekly clinical examinations
    Comparison poor
    Outcome independence