title: Reduction of disability after stroke is a more informative predictor of long-time survival than initial disability status.
abstract: OBJECTIVE
  Few studies have evaluated the roles of reducing disability after stroke in predicting survival. This study aimed to investigate the effects of improvement in the Barthel Index (BI) and other prognostic factors on survival in patients with first-time noncardioembolic ischemic stroke.
  
  
  METHODS
  BI effectiveness was defined as the improvement of BI between initial stroke (within 3 days) and 2 months after stroke. Cox regression analysis and Kaplan-Meier methods were used to evaluate the predictive roles of various prognostic factors.
  
  
  RESULTS
  A total of 111 patients were enrolled. Mean age at the time of stroke was 68 (+ or - 11.2) years. Median follow-up time was 77.4 months. Mean initial BI was 36.1 (+ or - 28.5) and mean BI effectiveness was 46.9 + or - 29.0. Overall, 55 deaths (49.5%) of the cohort were ascertained. The BI effectiveness had significant effects on long-time survival while initial BI was not a significant predictor. Higher BI effectiveness led to lower risk of mortality (hazard ratio = 0.44, 95% CI 0.24 - 0.80, p = 0.007). Elder age was correlated with poor survival (overall p = 0.006). Subjects in the eldest age group (> or = 70 years) showed a significant elevated risk for death (hazard ratio = 3.42, 95% CI 1.18 - 9.92). There was a trend indicating that the smaller the lesion size, the more favourable the prognosis (overall p = 0.057).
  
  
  CONCLUSIONS
  BI effectiveness in the first 2 months after first-time noncardioembolic stroke was more informative than initial disability status for predicting long-time mortality. It highlights the potential benefit in maximizing functional performance in patients with stroke.
authors: Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei.
authors: Shin-Liang
authors: SL
authors: Pan
authors: Shwu-Chong
authors: SC
authors: Wu
authors: Ti-Kai
authors: TK
authors: Lee
authors: Tony Hsiu-Hsi
authors: TH
authors: Chen
mesh_terms: D000368:Aged; D005260:Female; D006304:Health Status; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011379:Prognosis; D012307:Risk Factors; D020521:Stroke / Q000401:mortality*; D000071939:Stroke Rehabilitation; D016019:Survival Analysis