Assessment of functioning and disability after ischemic stroke.
OBJECTIVE
Functioning and disability after ischemic stroke are clinically meaningful and of major relevance to patients. Despite many instruments available to assess these outcomes, little is known about their interrelation and predictive factors.


METHODS
We prospectively identified 4264 patients with acute ischemic stroke from 30 hospitals in Germany during a 1-year period between 1998 and 1999 and registered them in a common data bank. The patients were centrally followed up via telephone interview after 100 days and 1 year to assess various scales such as the Barthel Index (BI), modified Rankin Scale (MRS), extended Barthel Index (EBI), Short Form-36 Physical Functioning (SF-36 PF), and Center for Epidemiologic Studies-Depression short form (CES-D).


RESULTS
Outcome status could be assessed in 67.2% of patients 100 days after hospital admission. Of these, 13.9% had died, 53.7% had regained functional independence (BI <95), 46.3% had no or mild residual symptoms (MRS < or =1), and 44.6% had no higher cognitive deficits on the EBI. Of the patients who personally answered the follow-up questions, 67% had no major physical disability (SF-36 PF <60), and 32.9% reported symptoms classified as depression (CES-D > or =10). The high percentage of patients reaching the maximum score (ceiling effect) in the BI was less pronounced in the MRS and SF-36 PF. The predictive factors for dichotomized outcomes on each scale were similar for adverse functioning and disability but varied considerably for depression.


CONCLUSIONS
To avoid ceiling effects in outcome distribution of patients treated in specialized stroke centers, the MRS and SF-36 PF instruments are preferable to the BI. Parametric use of the SF-36 PF could further improve outcome measurement by considering individual treatment effects.
Weimar
Christian
C
Department of Neurology, University of Essen, Essen, Germany.
Kurth
Tobias
T
Kraywinkel
Klaus
K
Wagner
Markus
M
Busse
Otto
O
Haberl
Roman Ludwig
RL
Diener
Hans-Christoph
HC
D000368:Aged; D002545:Brain Ischemia / Q000150:complications / Q000503:physiopathology* / Q000534:rehabilitation*; D015331:Cohort Studies; D003863:Depression / Q000150:complications / Q000175:diagnosis; D004185:Disability Evaluation; D005260:Female; D005500:Follow-Up Studies; D005858:Germany; D006801:Humans; D016015:Logistic Models; D008297:Male; D009483:Neuropsychological Tests / Q000706:statistics & numerical data*; D016017:Odds Ratio; D017063:Outcome Assessment, Health Care / Q000706:statistics & numerical data*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D015203:Reproducibility of Results; D012307:Risk Factors; D020521:Stroke / Q000150:complications / Q000503:physiopathology*; D000071939:Stroke Rehabilitation; D011795:Surveys and Questionnaires