Predicting Disability in Stroke—A Critical Review of the Literature

Abstract

SummaryResearch articles on the prognosis of stroke patients were analysed to identify studies that met sound methodological principles of prognostic research as well as to identify variables capable of predicting functional outcome (ADL) after stroke. Data sources comprised a computer-aided search of published prognostic studies and references to literature used in prognostic studies. Seventy-eight studies were tested for adherence to the following key methodological criteria: reliability and validity of measurement instruments used to assess dependent and independent variables; inclusion of an inception cohort; adequate and uniform end-point of observation; control for drop-outs during period of observation; statistical testing of presumed relationship between dependent and independent variables; sufficient sample size in relation to number of determinants; control for multicollinearity; specification of patient characteristics (i.e. age, type, recurrent stroke and localization of stroke); description of interfering treatment effects during the period of observation; and crossvalidation of the prediction model in a second independent group of patients.Only three studies satisfied nine out of 11 criteria and ten studies eight criteria for the determination of valid prognostic research. The results of these studies indicate that the following variables are valid predictors for functional recovery after stroke: age; previous stroke; urinary continence; consciousness at onset; disorientation in time and place; severity of paralysis; sitting balance; admission ADL score; level of social support and metabolic rate of glucose outside the infarct area in hypertensive patients. This study supports the general opinion that not only are differences in objectives and heterogeneity in stroke patients responsible for the lack of accuracy in predicting functional outcome, but also the methodological flaws in published prognostic research.

Course of functional status and pain in osteoarthritis of the hip or knee: A systematic review of the literature

“…The methodologic quality of each included study was independently assessed by 2 reviewers (GMD and CV) using a standardized set of 11 predefined criteria (Table 1). These criteria were based on lists of methodologic criteria used in previous reviews of prognosis and observational studies in the field of musculoskeletal disorders (5,22,23) and included items for both internal and external validity. Conflicting scores for the various items were discussed until consensus was reached.…”

“…A distinction was made between studies with a followup of 6 -36 months and studies with a followup Ͼ3 years, because this criterion was used as a cutoff point for higher methodologic quality in our list of criteria for methodologic quality and in previous reviews (5,22,23).…”

Associations between psychological factors and quality of life ratings in persons with spinal cord injury: a systematic review

“…The checklist is a combination of the methodological quality list developed by Kwakkel et al, 10 and the checklist to evaluate the quality of studies designed by Downs and Black. 11 These two instruments were merged to obtain a brief, clear and easy to use checklist.…”

A narrative review on haptic devices: relating the physiology and psychophysical properties of the hand to devices for rehabilitation in central nervous system disorders

“…Similarly, strokes in the thalamus [34], sensory cortex (in the parietal lobes) [34], or dorsal pontine area of the brain stem [35] cause both sensory loss and disordered motor control. Somatosensory loss has been associated with uncoordinated movement at the shoulder, elbow and hand [36], ineffectual regulation of grip forces [37], impaired motor learning [38] and reduced functional recovery [39]. Collectively, this evidence of the importance of somatosensory-motor integration to motor function provides an explicit theoretical rationale for the inclusion of haptic devices into neurorehabilitation.…”