Predictors of Functional Dependency after Stroke in Nigeria

Abstract

The factors impacting poststroke functional dependency have not been adequately explored in sub-Saharan Africa. This study examined the risk factors for functional dependency in a group of Nigerian African stroke survivors. One hundred twenty-eight stroke survivors attending a tertiary general hospital in southwestern Nigeria were consecutively recruited and assessed for functional dependency using the modified Rankin Scale (mRS). Stroke was diagnosed according to the World Health Organization criteria. Candidate independent variables assessed included the demographic and clinical characteristics of survivors, cognitive dysfunction, and a diagnosis of major depressive disorder. Variables with significant relationship to functional dependency were entered into a logistic regression model to identify factors that were predictive of functional dependency among the stroke survivors. In all, 60.9% of the stroke survivors were functionally dependent (mRS scores≥3), with mean±SD mRS scores of 2.71±1.01. Female sex (P=.003; odds ratio [OR] 3.08; 95% confidence interval [CI] 1.47-6.44), global cognitive dysfunction (P=.002; OR 5.04; 95% CI 1.79-14.16), and major depressive disorder (P<.0001; OR 3.06; 95% CI 1.92-4.87) were strongly associated with functional dependency in univariate analysis. Major depressive disorder was an independent predictor of functional dependency in multivariate analysis (P<.0001; OR 6.89; 95% CI 2.55-18.6; R2=0.19). Depression, female sex, and cognitive dysfunction were strongly associated with poorer functioning after stroke. Interventions aimed at depression and cognitive dysfunction after stroke may improve functional independence in stroke survivors.