Late Functional Improvement Tied to Better Long-term Post-stroke Outcomes

Sarfaroj Khan 

July 06, 2020

Takeaway

  • Late functional improvement between 3 and 12 months post-stroke 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 post-stroke.

Study design

  • This analysis of the prospective, population-based Oxford Vascular study (OXVASC) included 1288 1-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 post-stroke 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 post-stroke.

  • 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.

 

Ganesh A, Luengo-Fernandez R, Rothwell PM. Late functional improvement and 5-year poststroke outcomes: a population-based cohort study. J. Neurol. Neurosurg. Psychiatry. 2020 Jun 23 [Epub ahead of print]. doi: 10.1136/jnnp-2019-322365. PMID: 32576613 Abstract. 

This clinical summary first appeared on Univadis, part of the Medscape Professional Network.

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