Recovery, Functional Status, and Health-Related Quality of Life status up to 4 years after first ever stroke onset. A population-based study.

Abstract

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. 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' functional status and independency with 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. 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-years follow-up period. Among the 202 follow-up attendees, 147 (73%) had favorable functional outcome (mRS ≤2); and 134 (69%) of 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 in-home 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 Ssmall Artery Occlusion than other pathogenetic mechanisms (20% and 33% vs. 56-68%; p<0.01). SIS respondents with poor functional outcome (n=32) reported worst outcome in the hand domain of SIS (median: 28/100; IQR 0-73). Most 3-4-year stroke survivors have favorable functional outcome 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. .