Stroke: old age, lesion type, lesion site, incontinence, dysphagia and absence of committed caregiver may affect outcome.

Clinical bottom line (level 4)

  1. Patients with a primary diagnosis of stroke may be at an increased risk of a poor outcome at a mean of 33 months if they are older aged, have a severe deficit, have a large-vessel stroke, have a bilateral or right-sided stroke, are incontinent or dysphagic or do not have a committed caregiver at admission to rehabilitation.
Ween et al: Neurology 1996; 47: 388-392
Expires December 2002

The study

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

Setting: general hospital, USA

421 patients (aged mean 73 years, 55% female) primary diagnosis of stroke

Excluded if
  • subarachnoid haemorrhage
  • stroke requiring cerebral surgical interventions
  • discharged to acute care hospitals for intercurrent acute events during rehabilitation
  • death during rehabilitation






    • 89% followed for mean 33 months
    Outcomes studied:

    The evidence


    • Age was found to have an influence on Functional Independence Measure (F=8.70; p<0.003).
    • Severity of deficit was found to have an influence on Functional Independence Measure (F=8.39; p=0.004).
    • Lesion type was found to influence outcome, with large-vessel strokes worse than small-vessel strokes or haemorrhages. (F=5.56; p=0.001).
    • Lesion site influenced Functional Independence Measure, with bilateral and right-sided lesions worse than left-sided (F=4.36; p<0.005).
    • Incontinence and dysphagia had an influence on all outcomes.
    • Absence of a committed caregiver identified on admission to rehabilitation significantly reduced the rate of home discharge ( ? ² =5.75; p<0.05).

    Comments

    1. No data on odds ratios or relative risks were given: FIM is a continuous outcome measure.

    Citation

    1. Ween JE, Alexander MP, D'Esposito M, et al: Factors predictive of stroke outcome in a rehabilitation setting. Neurology 1996; 47: 388-392
    Contributor: Clare Wotton and Bob Phillips, December 1999
    Reviewer:

    Clinical Question.
    Patient stroke requiring rehabilitation
    Intervention or Exposure presence of prognostic factors
    Comparison absence of prognostic factors
    Outcome functional improvement and disposition