Assessment of Comorbidity Burden and its Association With Functional Rehabilitation Outcome After Stroke or Hip Fracture: A Systematic Review and Meta-Analysis

Kabboord, Anouk D.; Eijk, Monica van; Fiocco, Marta; Balen, Romke van; Achterberg, Wilco P.

doi:10.1016/j.jamda.2016.07.028

Cited by 48 publications

(47 citation statements)

References 43 publications

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“…A modest association between MCC and poststroke FO in patients from inpatient rehabilitation was reported in a recent literature review [24]; however, this patient population is not a representative sample of the stroke patient population. The role of MCC in predicting FO in the broader stroke population is less well understood.…”

Section: Introductionmentioning

confidence: 79%

Multiple Chronic Conditions and Functional Outcome after Ischemic Stroke: A Systematic Review and Meta-Analysis

et al. 2019

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Background: Multiple chronic conditions (MCC) contribute to functional disability in the general population although its role in predicting functional outcome (FO) among patients with stroke is not well understood. There is no universal agreement on the approach to measuring MCC in stroke, and findings have been mixed regarding MCC being an independent predictor for poststroke FO. Objectives: This review aims to summarize the findings of studies that have investigated the relationship between MCC and FO after ischemic stroke using a MCC index. Method: PubMed and Embase were systematically searched for studies conducted among ischemic stroke patients that have examined the adjusted association between prestroke MCC and FO. The quality of the included studies was appraised using a risk of bias (RoB) assessment checklist. A meta-analysis was performed for the association between MCC and FO using a random effects model to estimate the overall pooled ORs. Results: Twelve of the 18 studies included were hospital-based co-hort studies, with a median RoB score of 4.75 points (range 1-9, higher scores for higher RoB). Studies predominantly used the Charlson Comorbidity Index (CCI), or the Modified CCI to measure MCC burden, and the modified Rankin scale to measure FO. Half of the studies reported a significant negative association between MCC and FO, which was also found by the meta-analysis with a pooled OR of 1.11 (95% CI 1. 05-1.18). Conclusions: The current review supports that increased MCC is associated with worse poststroke FO although population-based studies of this association are lacking. Future research should aim to develop more refined measures of MCC that consider the severity and interactions of comorbid conditions reflective of the broader stroke population and to understand the relationship between MCC and poststroke FO with thorough adjustment for confounding factors.

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Section: Introductionmentioning

confidence: 79%

Multiple Chronic Conditions and Functional Outcome after Ischemic Stroke: A Systematic Review and Meta-Analysis

et al. 2019

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“…Given the increasing demand for and limited capacity of rehabilitation services, there is growing interest in factors which may predict functional outcome following stroke and allow more effective targeting of resources 26 . Presence of specific comorbidities can affect functional outcomes following stroke.…”

Section: Functional Outcomesmentioning

confidence: 99%

“…Studies quantifying the relationship between multimorbidity and functional outcomes have reported contradictory findings 19,20,26,[29][30][31][32] . There is variability both in the choice of scale used to quantify multimorbidity, and in the assessment of functional outcome.…”

Section: Functional Outcomesmentioning

confidence: 99%

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Multimorbidity in Stroke

Gallacher

Jani

Hanlon

et al. 2019

Stroke

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“…Populations at high risk for increased morbidity and mortality following a hip fracture include those with multimorbidity, frailty and protein energy malnutrition. A correlation between comorbidity at discharge and poor functional outcomes has been demonstrated (20). Persons with the physical frailty phenotype have an increased risk of fractures in general and poor surgical outcomes (21,22).…”

Section: High Risk Populationsmentioning

confidence: 99%