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Predictors of functional level and quality of life at 6 months after a first-ever stroke: the KOSCO study

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Abstract

Predicting functional outcome and quality of life (QOL) is critical to the treatment of patients with stroke. The purpose of this study was to analyze the factors influencing functional status and QOL of stroke patients 6 months after a first-ever stroke. This study was an interim analysis of the Korean Stroke Cohort for Functioning and Rehabilitation Study, designed to include 10 years of follow-up for first-ever stroke patients. This study analyzed data from 2857 patients who completed face-to-face assessments with the functional independence measurement (FIM) and Euro Quality of Life-5D (EQ-5D) at 6 months after stroke onset. A multivariate regression analysis was used to analyze factors that potentially influenced FIM and EQ-5D results at 6 months after stroke. Of the patients in this study, 80.1 % suffered from ischemic stroke and 19.9 % experienced hemorrhagic stroke. The independent predictors of functional independency measured by FIM at 6 months after stroke were age, initial stroke severity, duration of hospitalization, and functional level at discharge in terms of motor, ambulation, and language. For QOL measured by EQ-5D at 6 months after stroke, age, duration of hospitalization, and motor function at discharge were significant predictors. In conclusion, proper treatment to achieve maximal functional gain at discharge may be an important factor in improving functional independency and QOL in chronic stage stroke survivors. These results provide useful information for establishing comprehensive and systematic care for stroke patients.

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References

  1. Mukherjee D, Patil CG (2011) Epidemiology and the global burden of stroke. World Neurosurg 76:S85–S90

    Article  PubMed  Google Scholar 

  2. Barker-Collo S, Feigin VL, Parag V, Lawes CM, Senior H (2010) Auckland stroke outcomes study. Part 2: cognition and functional outcomes 5 years poststroke. Neurology 75:1608–1616

    Article  CAS  PubMed  Google Scholar 

  3. Langhorne P, Bernhardt J, Kwakkel G (2011) Stroke rehabilitation. Lancet 377:1693–1702

    Article  PubMed  Google Scholar 

  4. Veerbeek JM, Kwakkel G, van Wegen EE, Ket JC, Heymans MW (2011) Early prediction of outcome of activities of daily living after stroke: a systematic review. Stroke 42:1482–1488

    Article  PubMed  Google Scholar 

  5. Kwakkel G, Kollen BJ (2013) Predicting activities after stroke: what is clinically relevant? Int J Stroke 8:25–32

    Article  CAS  PubMed  Google Scholar 

  6. Weimar C, Konig IR, Kraywinkel K, Ziegler A, Diener HC, German Stroke Study C (2004) Age and National Institutes of Health Stroke Scale Score within 6 hours after onset are accurate predictors of outcome after cerebral ischemia: development and external validation of prognostic models. Stroke 35:158–162

    Article  CAS  PubMed  Google Scholar 

  7. Feigin VL, Barker-Collo S, Parag V, Senior H, Lawes CM, Ratnasabapathy Y, Glen E, Group AS (2010) Auckland stroke outcomes study. Part 1: gender, stroke types, ethnicity, and functional outcomes 5 years poststroke. Neurology 75:1597–1607

    Article  CAS  PubMed  Google Scholar 

  8. Bernhardt J, Dewey H, Thrift A, Collier J, Donnan G (2008) A very early rehabilitation trial for stroke (AVERT): phase II safety and feasibility. Stroke 39:390–396

    Article  PubMed  Google Scholar 

  9. Slot KB, Berge E, Dorman P, Lewis S, Dennis M, Sandercock P, Oxfordshire Community Stroke Project tIST, Lothian Stroke R (2008) Impact of functional status at 6 months on long term survival in patients with ischaemic stroke: prospective cohort studies. BMJ 336:376–379

    Article  Google Scholar 

  10. Toschke AM, Tilling K, Cox AM, Rudd AG, Heuschmann PU, Wolfe CD (2010) Patient-specific recovery patterns over time measured by dependence in activities of daily living after stroke and post-stroke care: the South London Stroke Register (SLSR). Eur J Neurol 17:219–225

    Article  CAS  PubMed  Google Scholar 

  11. Grube MM, Koennecke HC, Walter G, Thummler J, Meisel A, Wellwood I, Heuschmann PU, Berlin Stroke R (2012) Association between socioeconomic status and functional impairment 3 months after ischemic stroke: the Berlin Stroke Register. Stroke 43:3325–3330

    Article  PubMed  Google Scholar 

  12. Putman K, De Wit L, Schoonacker M, Baert I, Beyens H, Brinkmann N, Dejaeger E, De Meyer AM, De Weerdt W, Feys H, Jenni W, Kaske C, Leys M, Lincoln N, Schuback B, Schupp W, Smith B, Louckx F (2007) Effect of socioeconomic status on functional and motor recovery after stroke: a European multicentre study. J Neurol Neurosurg Psychiatry 78:593–599

    Article  PubMed  PubMed Central  Google Scholar 

  13. Jakovljevic D, Sarti C, Sivenius J, Torppa J, Mahonen M, Immonen-Raiha P, Kaarsalo E, Alhainen K, Kuulasmaa K, Tuomilehto J, Puska P, Salomaa V (2001) Socioeconomic status and ischemic stroke: the FINMONICA stroke register. Stroke 32:1492–1498

    Article  CAS  PubMed  Google Scholar 

  14. van den Bos GA, Smits JP, Westert GP, van Straten A (2002) Socioeconomic variations in the course of stroke: unequal health outcomes, equal care? J Epidemiol Community Health 56:943–948

    Article  PubMed  PubMed Central  Google Scholar 

  15. Kerr GD, Higgins P, Walters M, Ghosh SK, Wright F, Langhorne P, Stott DJ (2011) Socioeconomic status and transient ischaemic attack/stroke: a prospective observational study. Cerebrovasc Dis 31:130–137

    Article  PubMed  Google Scholar 

  16. Guajardo VD, Terroni L, Sobreiro Mde F, Zerbini MI, Tinone G, Scaff M, Iosifescu DV, de Lucia MC, Fraguas R (2015) The influence of depressive symptoms on quality of life after stroke: a prospective study. J Stroke Cerebrovasc Dis 24:201–209

    Article  PubMed  Google Scholar 

  17. Chang WH, Sohn MK, Lee J, Kim DY, Lee SG, Shin YI, Oh GJ, Lee YS, Joo MC, Han EY, Kim YH (2015) Korean Stroke Cohort for functioning and rehabilitation (KOSCO): study rationale and protocol of a multi-centre prospective cohort study. BMC Neurol 15:42

    Article  PubMed  PubMed Central  Google Scholar 

  18. Dodds TA, Martin DP, Stolov WC, Deyo RA (1993) A validation of the functional independence measurement and its performance among rehabilitation inpatients. Arch Phys Med Rehabil 74:531–536

    Article  CAS  PubMed  Google Scholar 

  19. Greiner W, Claes C, Busschbach JJ, von der Schulenburg JM (2005) Validating the EQ-5D with time trade off for the German population. Eur J Health Econ 6:124–130

    Article  CAS  PubMed  Google Scholar 

  20. Kang EHS (2006) A valuation of health status using EQ-5D. Korean J Health Econ Policy 12:19–43

    Google Scholar 

  21. Oh MS, Yu KH, Lee JH, Jung S, Ko IS, Shin JH, Cho SJ, Choi HC, Kim HH, Lee BC (2012) Validity and reliability of a Korean Version of the National Institutes of Health Stroke Scale. J Clin Neurol 8:177–183

    Article  PubMed  PubMed Central  Google Scholar 

  22. Teasdale G, Knill-Jones R, van der Sande J (1978) Observer variability in assessing impaired consciousness and coma. J Neurol Neurosurg Psychiatry 41:603–610

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  23. Kang Y, Na DL, Hahn S (1997) A validity study on the Korean Mini-Mental State Examination (K-MMSE) in dementia patients. J Korean Neurol Assoc 15:300–308

    Google Scholar 

  24. Fugl-Meyer AR, Jaasko L, Leyman I, Olsson S, Steglind S (1975) The post-stroke hemiplegic patient. 1. A method for evaluation of physical performance. Scand J Rehabil Med 7:13–31

    CAS  PubMed  Google Scholar 

  25. Holden MK, Gill KM, Magliozzi MR, Nathan J, Piehl-Baker L (1984) Clinical gait assessment in the neurologically impaired. Reliability and meaningfulness. Phys Ther 64:35–40

    CAS  PubMed  Google Scholar 

  26. Wesling M, Brady S, Jensen M, Nickell M, Statkus D, Escobar N (2003) Dysphagia outcomes in patients with brain tumors undergoing inpatient rehabilitation. Dysphagia 18:203–210

    Article  PubMed  Google Scholar 

  27. Pyun SB, Hwang YM, Ha JW, Yi H, Park KW, Nam K (2009) Standardization of Korean Version of Frenchay Aphasia Screening test in normal adults. J Korean Acad Rehabil Med 33:436–440

    Google Scholar 

  28. Bernardini J, Callen S, Fried L, Piraino B (2004) Inter-rater reliability and annual rescoring of the Charlson comorbidity index. Adv Perit Dial 20:125–127

    PubMed  Google Scholar 

  29. Burn JP (1992) Reliability of the modified Rankin Scale. Stroke 23:438

    CAS  PubMed  Google Scholar 

  30. Kwakkel G, Veerbeek JM, Harmeling-van der Wel BC, van Wegen E, Kollen BJ, Early Prediction of functional Outcome after Stroke I (2011) Diagnostic accuracy of the Barthel Index for measuring activities of daily living outcome after ischemic hemispheric stroke: does early poststroke timing of assessment matter? Stroke 42:342–346

    Article  PubMed  Google Scholar 

  31. Heuschmann PU, Wiedmann S, Wellwood I, Rudd A, Di Carlo A, Bejot Y, Ryglewicz D, Rastenyte D, Wolfe CD, European Registers of S (2011) Three-month stroke outcome: the European Registers of Stroke (EROS) investigators. Neurology 76:159–165

    Article  CAS  PubMed  Google Scholar 

  32. Ingeman A, Andersen G, Hundborg HH, Svendsen ML, Johnsen SP (2011) In-hospital medical complications, length of stay, and mortality among stroke unit patients. Stroke 42:3214–3218

    Article  PubMed  Google Scholar 

  33. Parker VM, Wade DT, Langton Hewer R (1986) Loss of arm function after stroke: measurement, frequency, and recovery. Int Rehabil Med 8:69–73

    Article  CAS  PubMed  Google Scholar 

  34. Meijer R, van Limbeek J, Peusens G, Rulkens M, Dankoor K, Vermeulen M, de Haan RJ (2005) The stroke unit discharge guideline, a prognostic framework for the discharge outcome from the hospital stroke unit. A prospective cohort study. Clin Rehabil 19:770–778

    Article  CAS  PubMed  Google Scholar 

  35. Kim BR, Han EY, Joo SJ, Kim SY, Yoon HM (2014) Cardiovascular fitness as a predictor of functional recovery in subacute stroke patients. Disabil Rehabil 36:227–231

    Article  PubMed  Google Scholar 

  36. Gialanella B, Ferlucci C (2010) Functional outcome after stroke in patients with aphasia and neglect: assessment by the motor and cognitive functional independence measure instrument. Cerebrovasc Dis 30:440–447

    Article  PubMed  Google Scholar 

  37. Westendorp WF, Nederkoorn PJ, Vermeij JD, Dijkgraaf MG, van de Beek D (2011) Post-stroke infection: a systematic review and meta-analysis. BMC Neurol 11:110

    Article  PubMed  PubMed Central  Google Scholar 

  38. Bartley PC, Rezvani AH (2012) Alcohol and cognition—consideration of age of initiation, usage patterns and gender: a brief review. Curr Drug Abuse Rev 5:87–97

    Article  PubMed  Google Scholar 

  39. Holmes MV, Dale CE, Zuccolo L, Silverwood RJ, Guo Y, Ye Z, Prieto-Merino D, Dehghan A, Trompet S, Wong A, Cavadino A, Drogan D, Padmanabhan S, Li S, Yesupriya A, Leusink M, Sundstrom J, Hubacek JA, Pikhart H, Swerdlow DI, Panayiotou AG, Borinskaya SA, Finan C, Shah S, Kuchenbaecker KB, Shah T, Engmann J, Folkersen L, Eriksson P, Ricceri F, Melander O, Sacerdote C, Gamble DM, Rayaprolu S, Ross OA, McLachlan S, Vikhireva O, Sluijs I, Scott RA, Adamkova V, Flicker L, Bockxmeer FM, Power C, Marques-Vidal P, Meade T, Marmot MG, Ferro JM, Paulos-Pinheiro S, Humphries SE, Talmud PJ, Mateo Leach I, Verweij N, Linneberg A, Skaaby T, Doevendans PA, Cramer MJ, van der Harst P, Klungel OH, Dowling NF, Dominiczak AF, Kumari M, Nicolaides AN, Weikert C, Boeing H, Ebrahim S, Gaunt TR, Price JF, Lannfelt L, Peasey A, Kubinova R, Pajak A, Malyutina S, Voevoda MI, Tamosiunas A, Maitland-van der Zee AH, Norman PE, Hankey GJ, Bergmann MM, Hofman A, Franco OH, Cooper J, Palmen J, Spiering W, de Jong PA, Kuh D, Hardy R, Uitterlinden AG, Ikram MA, Ford I, Hypponen E, Almeida OP, Wareham NJ, Khaw KT, Hamsten A, Husemoen LL, Tjonneland A, Tolstrup JS, Rimm E, Beulens JW, Verschuren WM, Onland-Moret NC, Hofker MH, Wannamethee SG, Whincup PH, Morris R, Vicente AM, Watkins H, Farrall M, Jukema JW, Meschia J, Cupples LA, Sharp SJ, Fornage M, Kooperberg C, LaCroix AZ, Dai JY, Lanktree MB, Siscovick DS, Jorgenson E, Spring B, Coresh J, Li YR, Buxbaum SG, Schreiner PJ, Ellison RC, Tsai MY, Patel SR, Redline S, Johnson AD, Hoogeveen RC, Hakonarson H, Rotter JI, Boerwinkle E, de Bakker PI, Kivimaki M, Asselbergs FW, Sattar N, Lawlor DA, Whittaker J, Davey Smith G, Mukamal K, Psaty BM, Wilson JG, Lange LA, Hamidovic A, Hingorani AD, Nordestgaard BG, Bobak M, Leon DA, Langenberg C, Palmer TM, Reiner AP, Keating BJ, Dudbridge F, Casas JP, InterAct C (2014) Association between alcohol and cardiovascular disease: Mendelian randomisation analysis based on individual participant data. BMJ 349:g4164

    Article  PubMed  PubMed Central  Google Scholar 

  40. Hartman-Maeir A, Soroker N, Ring H, Avni N, Katz N (2007) Activities, participation and satisfaction 1-year post stroke. Disabil Rehabil 29:559–566

    Article  PubMed  Google Scholar 

  41. Baumann M, Le Bihan E, Chau K, Chau N (2014) Associations between quality of life and socioeconomic factors, functional impairments and dissatisfaction with received information and home-care services among survivors living at home 2 years after stroke onset. BMC Neurol 14:92

    Article  PubMed  PubMed Central  Google Scholar 

  42. van de Port IG, Kwakkel G, Schepers VP, Heinemans CT, Lindeman E (2007) Is fatigue an independent factor associated with activities of daily living, instrumental activities of daily living and health-related quality of life in chronic stroke? Cerebrovasc Dis 23:40–45

    Article  PubMed  Google Scholar 

  43. Cox AM, McKevitt C, Rudd AG, Wolfe CD (2006) Socioeconomic status and stroke. Lancet Neurol 5:181–188

    Article  PubMed  Google Scholar 

  44. Hudson CG (2005) Socioeconomic status and mental illness: tests of the social causation and selection hypotheses. Am J Orthopsychiatry 75:3–18

    Article  PubMed  Google Scholar 

  45. Aslanyan S, Weir CJ, Lees KR, Reid JL, McInnes GT (2003) Effect of area-based deprivation on the severity, subtype, and outcome of ischemic stroke. Stroke 34:2623–2628

    Article  PubMed  Google Scholar 

  46. Weir NU, Gunkel A, McDowall M, Dennis MS (2005) Study of the relationship between social deprivation and outcome after stroke. Stroke 36:815–819

    Article  PubMed  Google Scholar 

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Acknowledgments

This work was supported by the Research Program funded by the Korea Centers for Disease Control and Prevention (2013-2013E3301702) and by the National Research Foundation of Korea (NRF) grant funded by the Korea government (MSIP) (NRF-2014R1A2A1A01005128).

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Authors and Affiliations

  1. Department of Physical and Rehabilitation Medicine, Center for Prevention and Rehabilitation, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Ilwon-dong, Seoul, Republic of Korea

    Won Hyuk Chang, Chung Kang & Yun-Hee Kim

  2. Department of Rehabilitation Medicine, School of Medicine, Chungnam National University, Daejeon, Republic of Korea

    Min Kyun Sohn

  3. Department of Rehabilitation Medicine, Konkuk University School of Medicine, Seoul, Republic of Korea

    Jongmin Lee

  4. Department and Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea

    Deog Young Kim

  5. Department of Physical and Rehabilitation Medicine, Chonnam National University Medical School, Gwangju, Republic of Korea

    Sam-Gyu Lee

  6. Department of Rehabilitation Medicine, Pusan National University School of Medicine, Pusan National University Yangsan Hospital, Busan, Republic of Korea

    Yong-Il Shin

  7. Department of Preventive Medicine, Wonkwang University, School of Medicine, Iksan, Republic of Korea

    Gyung-Jae Oh

  8. Department of Rehabilitation Medicine, Kyungpook National University School of Medicine, Kyungpook National University Hospital, Daegu, Republic of Korea

    Yang-Soo Lee

  9. Department of Rehabilitation Medicine, Wonkwang University School of Medicine, Iksan, Republic of Korea

    Min Cheol Joo

  10. Department of Rehabilitation Medicine, Jeju National University Hospital, Jeju National University School of Medicine, Jeju, Republic of Korea

    Eun Young Han

  11. Department of Health Science and Technology, Department of Medical Device Management and Research, SAIHST, Sungkyunkwan University, Seoul, Republic of Korea

    Yun-Hee Kim

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  1. Won Hyuk Chang
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  2. Min Kyun Sohn
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  3. Jongmin Lee
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  7. Gyung-Jae Oh
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  8. Yang-Soo Lee
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  9. Min Cheol Joo
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Correspondence to Yun-Hee Kim.

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Chang, W.H., Sohn, M.K., Lee, J. et al. Predictors of functional level and quality of life at 6 months after a first-ever stroke: the KOSCO study. J Neurol 263, 1166–1177 (2016). https://doi.org/10.1007/s00415-016-8119-y

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  • DOI: https://doi.org/10.1007/s00415-016-8119-y

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