Motor and Functional Recovery After Stroke

Abstract

Background and Purpose— Outcome after first stroke varies significantly across Europe. This study was designed to compare motor and functional recovery after stroke between four European rehabilitation centers. Methods— Consecutive stroke patients (532 patients) were recruited. They were assessed on admission and at 2, 4, and 6 months after stroke with the Barthel Index, Rivermead Motor Assessment of Gross Function, Rivermead Motor Assessment of Leg/Trunk, Rivermead Motor Assessment of Arm, and Nottingham Extended Activities of Daily Living (except on admission). Data were analyzed using random effects ordinal logistic models adjusting for case-mix and multiple testing. Results— Patients in the UK center were more likely to stay in lower Rivermead Motor Assessment of Gross Function classes compared with patients in the German center (ΔOR, 2.4; 95% CI, 1.3 to 4.3). In the Swiss center, patients were less likely to stay in lower Nottingham Extended Activities of Daily Living classes compared with patients in the UK center (ΔOR, 0.7; 95% CI, 0.5 to 0.9). The latter were less likely to stay in lower Barthel Index classes compared with the patients in the German center (ΔOR, 0.6; 95%CI, 0.4 to 0.8). Recovery patterns of Rivermead Motor Assessment of Leg/Trunk and Rivermead Motor Assessment of Arm were not significantly different between centers. Conclusions— Gross motor and functional recovery were better in the German and Swiss centers compared with the UK center, respectively. Personal self-care recovery was better in the UK compared with the German center. Previous studies in the same centers indicated that German and Swiss patients received more therapy per day. This was not the result of more staff but of a more efficient use of human resources. This study indicates potential for improving rehabilitation outcomes in the UK and Belgian centers.

Functioning at 6 months post stroke following discharge from inpatient rehabilitation

“…9 However, participants received little input after discharge and 10% had no further contact with healthcare services. Consequently, potentially modifiable problems such as pain and depression were not identified and support of patients and caregivers over the transition after discharge was lacking.…”

“…CERISE included a multi-centre comparison between stroke rehabilitation units in Europe. 9 In our study, consecutive stroke patients were recruited between June 2005 and March 2006 from the Western Cape Rehabilitation Centre (WCRC), a regional specialist centre offering inpatient interdisciplinary rehabilitation. Inclusion criteria were: (i) first-ever stroke according to the World Health Organization definition of 'rapidly developing clinical signs of focal (or global) disturbance of cerebral function, with symptoms lasting 24 hours or leading to death, with no apparent cause other than vascular origin'; 10 (ii) admission to the WCRC within 3 months post stroke; (iii) 18 -85 years of age; (iv) living within 50 km of the WCRC.…”

“…Outcome measures in terms of stroke disability were: ADL independence according to the Barthel index (BI); 11 abilities for community living according to the Nottingham extended activities of daily living (NEADL) scale; 7,9,12 and global disability according to the Modified Rankin Scale (MRS) structured interview. 13,14 Responses to individual questions on the MRS structured interview were used to describe perceived changes in usual duties and activities -including work, family responsibilities, social and leisure activities -and relationships with family and friends.…”

Impact of post-stroke impairments on activities and participation as experienced by stroke survivors in a Western Cape setting

“…This time frame was selected to ensure that participants would not be interviewed earlier than six months post-stroke. These first six months are considered the period of fastest recovery after a stroke 13,14 .…”

Caregiver strain and quality of life 6 - 36 Months post stroke

“…This is despite there being evidence that rehabilitation or medical care that the patient receives in hospital determines the speed and extent of functional recovery (De Wit et al 2007;Kalra et al 2005). The lack of caregiver training and in patient rehabilitation prior to discharge could be due to the short hospital length of stay (LOS).…”