Susceptibility to deterioration of mobility long-term after stroke: a prospective cohort study.
OBJECTIVE
The aim of the present study was to identify clinical determinants able to predict which individuals are susceptible to deterioration of mobility from 1 to 3 years after stroke.


METHODS
Prospective cohort study of stroke patients consecutively admitted for inpatient rehabilitation. A total of 205 relatively young, first-ever stroke patients were assessed at 1 and 3 years after stroke. Mobility status was determined by the Rivermead Mobility Index (RMI), and decline was defined as a deterioration of > or =2 points on the RMI. Univariate and multivariate logistic regression analyses were performed to identify prognostic factors for mobility decline. The discriminating ability of the model was determined using a receiver operating characteristic curve.


RESULTS
A decline in mobility status was found in 21% of the patients. Inactivity and the presence of cognitive problems, fatigue, and depression at 1 year after stroke were significant predictors of mobility decline. The multivariate model showed a good fit (Hosmer-Lemeshow test P>0.05), and discriminating ability was good (area under the curve 0.79).


CONCLUSIONS
Mobility decline is an essential concern in chronic stroke patients, especially because it might lead to activities of daily living dependence and affects social reintegration. Early recognition of prognostic factors in patients at risk may guide clinicians to apply interventions aimed to prevent deterioration of mobility status in chronic stroke.
van de Port
Ingrid G L
IG
Center of Excellence for Rehabilitation Medicine Utrecht, Rehabilitation Center De Hoogstraat, Utrecht, The Netherlands. i.v.d.port@dehoogstraat.nl
Kwakkel
Gert
G
van Wijk
Iris
I
Lindeman
Eline
E
D000203:Activities of Daily Living; D000368:Aged; D003071:Cognition; D015331:Cohort Studies; D004185:Disability Evaluation; D004198:Disease Susceptibility; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D011379:Prognosis; D011446:Prospective Studies; D012372:ROC Curve; D012044:Regression Analysis; D012307:Risk Factors; D020521:Stroke / Q000473:pathology; D000071939:Stroke Rehabilitation