Prospective Study of Functional Recovery of Stroke Patients at Three Months Post Admission: Outcomes and Implications for Post Stroke Care Provision
Functional Recovery of Stroke Patients at 3 Months
Vol. 8 No. 1 : 2013 (19-27)
Abstract
Functional recovery in the immediate post stroke period predicts the long-term prognosis of post stroke patients. Despite the advancement in stroke rehabilitation in improving the physical function of survivors, there are other factors that may influence functional recovery. We aimed to assess the functional recovery of ischaemic stroke patients attending a tertiary hospital and its associated factors in order to make recommendations for post stroke care after hospital admission. A three months prospective observational study looking at functional recovery using the Modified Barthel’s Index (MBI) and depression (Patient Heath Questionnaire-9) score of post stroke patients. There were 46 ischaemic stroke patients who were recruited for the study. At three months, only 37 patients were eligible for analysis. The mean age was 67.2 (SD 11) years with the Malays (50%) making up the majority of the patients, followed by Chinese (41.3%) and Indians (8.7%). There was a total of seven (15.2%) deaths. Hypertension was the most common risk factor (89.1%) followed by dyslipidaemia (65.2%) and diabetes mellitus (63.0%). The mean MBI difference was 45.2 (SD 27.0) with a median MBI of 17.0(IQR 33.0) at baseline compared to 85.0(IQR 42.0) at three months (p < 0.001, CI 35.98,55.45). The prevalence of depression (PHQ-9≥10) was 21.6%. Lower functional recovery was found among depressed patients (p <0.026) and among patients with recurrent stroke (p< 0.035). Significant functional recovery can be seen as early as three-months post stroke. Factors such as recurrent stroke and depression may affect functional recovery post stroke; hence should be routinely screened.
Keywords :
acute stroke,
Cerebrovascular accident,
function recovery,
Malaysia,
patient admission,
rehabilitation,
Correspondance Address
Dr. Mohd Fairuz Ali, Department of Family Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Center, Jalan Yaacob Latif, Bandar Tun Razak, 56000 Cheras, Kuala Lumpur, Malaysia. Tel: 03-91456117 Fax: 03-91456680 Email: phere1@gmail.com
References
Aziz, N.A., Leonardi-Bee, J., Phillips, M., Gladman, J.R., Legg, L., Walker, M.F. 2008. Therapy-based rehabilitation services for patients living at home more than one year after stroke. Cochrane Database Syst Rev 2:CD005952.
Burke, T., Venketasubramanian, R. 2006. The epidemiology of stroke in the East Asian region: a literature-based review. Int J Stroke 1(4):208-215.
Dietrich, A.J., Oxman, T.E., Burns, M.R., Winchell, C.W, Chin, T. 2003. Application of a depression management office system in community practice: a demonstration. J Am Board Fam Pract 16(2):107-114.
Glamcevski, M.T., Pierson, J. 2005. Prevalence of and factors associated with poststroke depression: a Malaysian study. J Stroke Cerebrovasc Dis 14(4):157-161.
Hamidon, B., Raymond, A. 2003. Risk factors and complications of acute ischaemic stroke patients at Hospital Universiti Kebangsaan Malaysia (HUKM). Med J Malaysia 58(4):499-505.
Hankey, G., Jamrozik, K., Broadhurst, R., Forbes, S., Anderson, C. 2002. Long-term disability after first-ever stroke and related prognostic factors in the Perth Community Stroke Study, 1989-1990. Stroke 33(4):1034-1040.
Hatano, S. 1976. Experience from a multicentre stroke register: a preliminary report. Bull World Health Organ 54(5):541.
Internet Stroke Center. 2013. Stroke Statistics. Available from: http://www.strokecenter.org/patients/about-stroke/stroke-statistics/. [Accessed on 3/12/2013].
Jaya, F., Win, M.N., Abdullah, M.R., Abdullah, M.R., Abdullah, J.M. 2002. Stroke patterns in Northeast Malaysia: a hospital-based prospective study. Neuroepidemiology 21(1):28-35.
Jørgensen, H.S., Nakayama, H., Raaschou, H.O., Olsen, T.S. 1997. Acute stroke: prognosis and a prediction of the effect of medical treatment on outcome and health care utilization. The Copenhagen Stroke Study. Neurology 49(5):1335-1342.
Jørgensen, H.S., Nakayama, H., Raaschou, H.O., Vive-Larsen, J., Støier, M., Olsen, T.S. 1995. Outcome and time course of recovery in stroke. Part II: Time course of recovery. The copenhagen stroke study. Arch Phys Med Rehabil 76(5):406-412.
Kwakkel, G., Wagenaar, R.C., Kollen, B.J., Lankhorst, G.J. 1996. Predicting disability in stroke--a critical review of the literature. Age Ageing 25(6):479-489.
Langhorne, P., Bernhardt, J., Kwakkel, G. 2011. Stroke rehabilitation. Lancet 377(9778):1693-1702.
Langhorne, P., Coupar, F., Pollock, A. 2009. Motor recovery after stroke: a systematic review. Lancet Neurol 8(8):741-754.
Langhorne, P., Taylor, G., Murray, G., Dennis, M., Anderson, C., Bautz-Holter, E., Dey, P., Indredavik, B., Mayo, N., Power, M., Rodgers, H., Ronning, O.M., Rudd, A., Suwanwela, N., Widen-Holmqvist, L., Wolfe, C. 2005. Early supported discharge services for stroke patients: a meta-analysis of individual patients’ data. Lancet 365(9458):501-506.
Lotfi, L., Flyckt, L., Krakau, I., Mårtensson, B., Nilsson, G.H. 2010. Undetected depression in primary healthcare: occurrence, severity and co-morbidity in a two-stage procedure of opportunistic screening. Nord J Psychiatry 64(6):421-427.
Mahoney, F., Barthel, D.1965. Functional Evaluation: The Barthel Index. Md State Med J 14:61-65.
Ministry of Health (MOH). 2006. Clinical Practice Guidelines, Management of Stroke Available from: http://www.acadmed.org.my/index.cfm?&menuid=67. [Accessed on 21/5/2011].
Ministry of Health (MOH). 2009. Malaysian Health Facts 2009. Available from: http://www.moh.gov.my/v/stats_si. [Accessed on 10/10/2011].
Musicco, M., Emberti, L., Nappi, G., Caltagirone, C. 2003. Early and long-term outcome of rehabilitation in stroke patients: the role of patient characteristics, time of initiation, and duration of interventions. Arch Phys Med Rehabil 84(4):551-558.
National Institute for Health and Clinical Excellence (NICE). 2008. Stroke: the diagnosis and initial management of acute stroke and transient ischaemic attack. (Clinical guideline 68.) Available from: http://www.nice.org.uk/Guidance/CG68/NiceGuidance/pdf/English. [Accessed on 5/18/2013].
Oh, M.Y., Ko, S.B., Lee, S.H., Kim, C., Ryu, W.S., Kim, C.H., Yoon, B.W. 2014. Association between metabolic syndrome and functional outcome in patients with acute ischaemic stroke. Eur J Neurol 21(1):177-179
Ong, T.Z., Raymond, A.A. 2002. Risk Factors for Stroke and Predictors of One-Month Mortality. Singapore Med J 43(10):517-521.
Rameezan, B.A., Zaliha, O. 2005. Functional Status of Acute Stroke Patients in University Malaya Medical Centre (UMMC), Kuala Lumpur, Malaysia. Med J Malaysia 60(5):548-59.
Rampal, L., Rampal, S., Azhar, M.Z., Rahman, A.R. 2008. Prevalence, awareness, treatment and control of hypertension in Malaysia: A national study of 16,440 subjects. Public Health 122(1):11-18.
Rothwell, P.M., Coull, A.J., Giles, M.F., Howard, S.C., Silver, L.E., Bull, L.M., Gutnikov, S.A., Edwards, P., Mant, D., Sackley, C.M., Farmer, A., Sandercock, P.A., Dennis, M.S., Warlow, C.P., Bamford, J.M., Anslow, P. 2004. Change in stroke incidence, mortality, case-fatality, severity, and risk factors in Oxfordshire, UK from 1981 to 2004 (Oxford Vascular Study). Lancet 363(9425): 1925-1933.
Sangha, H., Lipson, D., Foley, N., Salter, K., Bhogal, S., Pohani, G., Teasell, R. 2005. A comparison of the Barthel Index and the Functional Independence Measure as outcome measures in stroke rehabilitation: patterns of disability scale usage in clinical trials. International Journal of Rehabilitation Research 28(2):135.
Shah, S., Vanclay, F. & Cooper, B. 1989. Improving The Sensitivity Of The Barthel Index For Stroke Rehabilitation. J Clin Epidemiol 42(8):703-709.
Spitzer, L.R., Williams, J.B.W., Kroenke, K. 1999. Patient Health Questionnaire. Prime Pfizer Incorporated.
Sulaiman AH, Zainal N, Tan KS, Tan C. 2002. Prevalence and associations of post-stroke depression. Neurol J Southeast Asia 7:71-75.
Krishnamoorthy, M. 2007. Killer Stroke: Six Malaysian Hit Every Hour. The Star Online. Available from: http://www.thestar.com.my/story.aspx/?file=%2f2007%2f4%2f24%2fnation%2f17524877 [Accessed on 8/25/2011].
Townend, B.S., Whyte, S., Desborough, T., Crimmins, D., Markus, R., Levi, C., Sturm, J.W. 2007. Longitudinal prevalence and determinants of early mood disorder post-stroke. J Clin Neurosci 14(5):429-434.
Venketasubramanian, N. 1999. Stroke in Singapore - An Overview. Singapore Med J 40(1):48-52.
Young, J. 2001. The primary care stroke gap. Br J Gen Pract 51(471):787-788.
Young, J., Forster, A. 2007. Review of stroke rehabilitation. BMJ 334(7584):86-90.
