Decline in physical performance among women with a recent transient ischemic attack or ischemic stroke: opportunities for functional preservation a report of the Women's Estrogen Stroke Trial.
OBJECTIVE
Physical performance for walking, reaching, turning, and other common tasks is a major determinant of functional independence after stroke. Current strategies to preserve physical performance focus on prevention of recurrent stroke. Loss of physical performance, however, may occur in the absence of recurrence. To examine this possibility, we measured change in physical performance, independent of subsequent stroke, among women with a recent ischemic stroke or transient ischemic attack (TIA).


METHODS
Among 664 postmenopausal women who participated in a clinical trial of estrogen therapy after stroke or TIA, we administered the Physical Performance Test (PPT) at baseline (mean 58 days from the cerebrovascular event) and annually. Women who died or had a stroke during follow-up were censored. Decline or improvement in physical performance was defined as a change in the PPT score from baseline of at least 3 points. Sustained decline or improvement was defined as 2 consecutive years during which the score had declined or improved, respectively, relative to the baseline score.


RESULTS
With each year of follow-up, a smaller proportion of the cohort demonstrated improvement (16% in year 1, 6% in year 5) and a larger proportion demonstrated decline (15% in year 1, 35% in year 5). In an analysis restricted to 259 women with 3 years of follow-up, 46 (18%) experienced a nonsustained decline in physical performance, and 39 (15%) experienced a sustained decline.


CONCLUSIONS
Decline in physical performance is common after an ischemic stroke or TIA even in the absence of a recurrent neurological event. Our findings suggest that specific interventions to maintain and improve physical performance may be important for reducing long-term disability.
Kernan
Walter N
WN
Department of Medicine, Yale University School of Medicine, P.O. Box 208025, New Haven, CT 06520-8025, USA. walter.kernan@yale.edu
Viscoli
Catherine M
CM
Brass
Lawrence M
LM
Gill
Thomas M
TM
Sarrel
Philip M
PM
Horwitz
Ralph I
RI
D000368:Aged; D002545:Brain Ischemia / Q000503:physiopathology / Q000517:prevention & control; D004311:Double-Blind Method; D004967:Estrogens / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D002546:Ischemic Attack, Transient / Q000503:physiopathology* / Q000517:prevention & control; D017698:Postmenopause / Q000502:physiology; D011597:Psychomotor Performance / Q000187:drug effects / Q000502:physiology; D020127:Recovery of Function / Q000187:drug effects / Q000502:physiology*; D012307:Risk Factors; D055502:Secondary Prevention; D020521:Stroke / Q000503:physiopathology* / Q000517:prevention & control; D016138:Walking / Q000502:physiology; D016387:Women's Health
D004967:Estrogens