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https://hdl.handle.net/2440/47121
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Type: | Journal article |
Title: | Long-term disability after first-ever stroke and related prognostic factors in the Perth Community Stroke Study, 1989-1990 |
Author: | Hankey, Graeme J. Jamrozik, Konrad Broadhurst, Robyn J. Forbes, Susanne Anderson, Craig S. |
Citation: | Stroke, 2002; 33(4):1034-1040 |
Publisher: | Lippincott Williams & Wilkins |
Issue Date: | 2002 |
ISSN: | 0039-2499 |
School/Discipline: | School of Population Health and Clinical Practice |
Abstract: | Background and Purpose— Few reliable estimates of the long-term functional outcome after stroke are available. This population-based study aimed to describe disability, dependency, and related independent prognostic factors at 5 years after a first-ever stroke in patients in Perth, Western Australia. Methods— All individuals with a suspected acute stroke who were resident in a geographically defined region (population, 138 708) of Perth, Western Australia, were registered prospectively and assessed according to standardized diagnostic criteria over a period of 18 months in 1989 to 1990. Patients were followed up prospectively at 4 and 12 months and 5 years after the index event. Results— There were 370 cases of first-ever stroke, and 277 patients survived to 30 days. Of these early survivors, 152 (55%) were alive at 5 years, and among those who were neither institutionalized (n=146) nor disabled (n=129) at the time of their stroke, 21 (14%) were institutionalized in a nursing home, and 47 (36%) were disabled. The most important predictors of death or disability at 5 years were increasing age, baseline disability defined by a Barthel Index score of <20/20 (odds ratio [OR], 6.3; 95% confidence interval [CI], 2.7 to 14), moderate hemiparesis (OR, 2.7; 95% CI, 1.1 to 6.2), severe hemiparesis (OR, 4.5; 95% CI, 1.1 to 19), and recurrent stroke (OR, 9.4; 95% CI, 3.0 to 30). A low level of activity before the stroke was a significant predictor of institutionalization, and subsequent recurrent stroke was a consistent, independent predictor of institutionalization, disability, and death or institutionalization, increasing the odds of each of these 3 adverse outcomes by 5- to 15-fold. Conclusions— Among 30-day survivors of first-ever stroke, about half survive 5 years; of survivors, one third remain disabled, and 1 in 7 are in permanent institutional care. The major modifiable predictors of poor long-term outcome are a low level of activity before the stroke and subsequent recurrent stroke. Efforts to increase physical activity among the elderly and to prevent recurrent stroke in survivors of a first stroke are likely to reduce the long-term burden of cerebrovascular disease. |
Keywords: | disability evaluation; stroke |
Description: | © 2002 American Heart Association |
DOI: | 10.1161/01.STR.0000012515.66889.24 |
Published version: | http://stroke.ahajournals.org/cgi/content/abstract/33/4/1034 |
Appears in Collections: | Public Health publications |
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