Systematic Review of Prognostic Models in Patients with Acute Stroke

Abstract

Prognostic models in stroke may be useful in clinical practice and research. We systematically reviewed the methodology and results of studies that have identified independent predictors of survival, independence in activities of daily living, and getting home in patients with acute stroke. Eligible studies (published in full in English) included at least 100 patients in whom at least 3 predictor variables were assessed within 30 days of stroke onset and who were followed up for at least 30 days. We recorded 25 indicators of the validity and practicality of each model and identified variables that were consistent independent predictors of each outcome. Eighty-three separate prognostic models were found but most had potentially serious deficiencies in internal and statistical validity, many had limited generalisability, and none had been adequately validated. Only 4 studies met 8 simple quality criteria. Over 150 different predictor variables have been analysed but most were assessed in only 1 or 2 models. None of the existing prognostic models have been sufficiently well developed and validated to be useful in either clinical practice or research. Better quality models must be produced to enable, for example, adequate case-mix correction when comparing outcome among different groups of stroke patients.

Developing Risk Prediction Models for Postoperative Pancreatic Fistula: a Systematic Review of Methodology and Reporting Quality

“…Common approaches include dichotomizing at the median value or choosing an optimal cutoff point based on minimizing a P value. Regardless of the approach used, the practice of artificially treating a continuous risk predictor as categorical should be avoided [23,24]; yet, this is often done in the development of risk prediction models [22,[24][25][26][27]. In this review, 86 % of studies were identified that all or some continuous risk predictors were dichotomized or categorized.…”

Influence of Kinesitherapy on Functional Independence in Patients with Supratentorial Unilateral Stroke in Chronic Period

“…This year plays a significant role in the long run (Counsell & Dennis, 2001;Kwakkel, et al, 1996;Dombovy, et al, 1986;Jongbloed, 1986).…”

“…A number of systemic studies have shown that the factors for restoring the ability to walk and carry out daily activities are related to improving functional independence (Kwakkel, et al, 1996;Mejer, et al, 2003;Dombovy, et al, 1986;Jongbloed, 1986;Counsell & Dennis, 2001). The importance of these studies is illustrated by the fact that more than a hundred studies have been published since 1950 (Kwakkel, et al, 1996;Kwakkel,1998;Dombovy, et al, 1986;Jongbloed, 1986;Shan, et al, 1990;Feigenson, 1979;Gresham, 1990).…”

“…An important factor is the ability to perform everyday activities immediately after the stroke reported by the Barthel index during the first 2 weeks. Other authors believe that improving day-to-day activities, overcoming heart failure and consciousness, are the most important factors in the first year after stroke this year playing a long-term role (Counsell & Dennis, 2001;Kwakkel, et al, 1996;Dombovy, et al, 1986;Jongbloed, 1986).…”

“…Important independent factors in functional independence in performing day-to-day activities are: (1) initial independence in performing daily activities as measured by Barthel Index; (2) urinary incontinence; (3) the level of consciousness within the first 24 hours of stroke; (4) the duration of the disease; (5) the recurrent stroke status; (6) the weight of the parentage; (7) the possibility of maintaining a sitting equilibrium when the patient is admitted; (8) orientation in time and space; (9) the availability of social and family support; (10) the presence of heart failure; (11) the presence of depression (Kwakkel, et al, 1996;Mejer, et al, 2003;Counsell & Dennis, 2001, Kauhanen, et al, 1999Kotila, et al, 1998).…”