We found a match
Your institution may have rights to this item. Sign in to continue.
- Title
Multifaceted Assessment of Functional Outcomes in Survivors of First-time Stroke.
- Authors
Shin, Seyoung; Lee, Yaesuel; Chang, Won Hyuk; Sohn, Min Kyun; Lee, Jongmin; Kim, Deog Young; Shin, Yong-Il; Oh, Gyung-Jae; Lee, Yang-Soo; Joo, Min Cheol; Lee, So Young; Song, Min-Keun; Han, Junhee; Ahn, Jeonghoon; Kim, Yun-Hee
- Abstract
This cohort study investigates changes in functional status up to 60 months after stroke in patients experiencing first-time stroke in Korea. Key Points: Question: How do long-term functional recovery patterns after stroke differ by functional domain and what factors are associated with these outcomes? Findings: In this cohort study of 4443 patients with strokes, early recovery curve, time to plateau, and long-term decline pattern differed by functional domain, age, initial stroke severity, and stroke type. Clinical and functional factors, including age, sex, and stroke type, were associated with activities of daily living performance at 60 months. Meaning: These findings may help clinicians develop better strategies for effective early stroke care and rehabilitation. Importance: Because stroke causes diverse functional deficits, understanding the long-term recovery pattern of each functional domain may inform prognosis and therapeutic strategies. Objective: To observe long-term changes in functional status and residual disability in survivors of first-time stroke. Design, Setting, and Participants: This cohort study was an interim analysis of the Korean Stroke Cohort for Functioning and Rehabilitation. Between August 2012 and May 2015, 7858 of 10 636 screened patients with first-time strokes from 9 district hospitals in Korea provided informed consent to participate. Data were analyzed from September 2021 through February 2022. Exposure: First-time stroke. Main Outcomes and Measures: Study data include multifaceted face-to-face functional assessments obtained at 8 to 9 points until 60 months after stroke onset. The Korean Mini-Mental State Examination (K-MMSE), Fugl-Meyer Assessment, Functional Ambulatory Category, American Speech-Language-Hearing Association National Outcome Measurement System Swallowing Scale, and Short Korean version of the Frenchay Aphasia Screening Test were performed from 7 days to 60 months after stroke. The Korean Modified Barthel Index was measured from 3 months to 60 months after stroke. Results: A total of 4443 patients (2649 men [59.62%]; mean [SD] age 62.13 [12.43] years) who underwent repeated functional assessments for 60 months after stroke (3508 patients with ischemic and 935 patients with hemorrhagic stroke) were included. Overall, functions plateaued between 12 and 18 months after stroke and declined after 30 months; for example, mean (SD) K-MMSE improved from 7 days (22.89 [7.89]) to 12 months (26.03 [5.48]) (P <.001), plateaued until 36 months (26.03 [5.84]), and decreased to 48 months (26.02 [5.82]) (P <.001). Interaction associations were found between time after stroke and age, stroke severity, and stroke type in functional assessment outcomes. For example, mean (SE) FMA for ages 65 years or younger vs older than 65 years was 81.64 (0.63) vs 80.69 (0.68) at 7 days and 91.28 (0.47) vs 88.46 (0.58) at 6 months (P for interaction <.001), and for IS vs HS, it was 84.46 (0.47) vs 69.02 (1.24) at 7 days and 91.20 (0.38) vs 85.51 (0.98) at 6 months (P for interaction <.001). Mean (SE) FMA was 94.39 (0.21) at 7 days and 97.57 (0.14) at 6 months for mild stroke, 44.69 (1.18) at 7 days and 70.43 (1.21) at 6 months for moderate stroke, and 13.22 (0.99) at 7 days and 48.07 (2.62) at 6 months for severe stroke (P for interaction <.001). Factors associated with activities of daily living independence at 60 months included older age (β per 1-year increase = −0.35; standard error [SE], 0.03; P <.001), male sex (β = 2.12; SE, 0.73; P =.004), and hemorrhagic stroke type (β vs ischemic stroke = 2.35; SE, 0.81; P =.004). Conclusions and Relevance: This study found that long-term recovery patterns in multifaceted functional domains differed from one another and varied by patient age, stroke severity, and stroke type. Understanding the diversity of long-term functional recovery patterns and factors associated with these outcomes in survivors of stroke may help clinicians develop strategies for effective stroke care and rehabilitation.
- Subjects
SOUTH Korea; STATISTICS; STROKE; REGRESSION analysis; NIH Stroke Scale; FUNCTIONAL assessment; T-test (Statistics); PSYCHOLOGICAL tests; STROKE patients; DESCRIPTIVE statistics; CHI-squared test; GLASGOW Coma Scale; RESEARCH funding; DATA analysis; DATA analysis software; LONGITUDINAL method; DISEASE complications
- Publication
JAMA Network Open, 2022, Vol 5, Issue 9, pe2233094
- ISSN
2574-3805
- Publication type
Article
- DOI
10.1001/jamanetworkopen.2022.33094