Self ratings of health predict functional outcome and recurrence free survival after stroke.
OBJECTIVE
To measure stroke victims' self rated health (SRH) status and SRH transition, and to compare how the two are prospectively associated with disability and recurrence free survival.


METHODS
Prospective case registry study with face to face follow up interviews at three months, one, two, and three years. Ascertained were SRH status and SRH transition using single question assessments, Barthel Index (BI), Frenchay Activities Index (FAI), and Mini Mental State Examination (MMSE).


METHODS
A multiethnic inner city population of 234 533.


METHODS
Patients surviving the initial three months after a first in a lifetime stroke in 1995 to 1998.


RESULTS
Of 690 stroke survivors 561 (81.3%) could complete the self report items. Answers to the item on SRH status did not vary significantly between the four follow up interviews. However, responses to the item on SRH transition changed significantly during follow up with three months ratings being more negative than all subsequent ratings. SRH transition, but not SRH status, showed a prospective association with long term outcome in multivariate analyses controlling for the BI, FAI, and MMSE. Compared with all other patients, patients reporting "Much worse health" at three months were more likely to be disabled ( = BI<20) at one year (OR 6.29, 95% CI 2.26 to 17.52) and their combined risk of stroke recurrence and death was increased over five years (HR 1.72, 95% CI 1.25 to 2.38).


CONCLUSIONS
Items on SRH should be used with caution in populations with high rates of disability and language problems, as many participants are unable to complete them. SRH transition may be a better predictor of disability and recurrence free survival after major medical events than SRH status.
Hillen
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Division of Primary Care and Public Health Sciences, Guy's, King's and St Thomas' School of Medicine, King's College, London, UK.
Davies
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Rudd
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Kieselbach
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Wolfe
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CD
D000368:Aged; D000369:Aged, 80 and over; D001294:Attitude to Health; D004185:Disability Evaluation; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006305:Health Status Indicators; D006801:Humans; D008131:London / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011379:Prognosis; D011446:Prospective Studies; D012008:Recurrence; D020521:Stroke / Q000453:epidemiology; D000071939:Stroke Rehabilitation