Patient-specific recovery patterns over time measured by dependence in activities of daily living after stroke and post-stroke care: the South London Stroke Register (SLSR).
OBJECTIVE
Data on patient-specific recovery after stroke are lacking and the effects of complex healthcare interventions on the course of recovery were not reported. To quantify the recovery pattern up to 1 year post-stroke and assess effects of evidence-based treatments on the patient-specific course of recovery allowing its prediction.


METHODS
A total of 355 patients after first-ever stroke from the population-based South London Stroke Register (source population >270,000) participated in a substudy between August 2002 and October 2004. At 1, 2, 3, 4, 6, 8, 12, 26, and 52 weeks post-stroke, Barthel Index (BI; ranging from 0 to 20) was documented. Multilevel growth models allowing predictions for patients with specific characteristics were calculated.


RESULTS
Mean age was 70 years, 48% were male and 23% died within the first year. The age-, gender- and stroke subtype-adjusted BI curve sharply increased until week 8 to 24 depending on patient characteristics and subsequently plateaued. Multivariable analysis identified stroke unit care, appropriate secondary prevention and physiotherapy for those with disabilities as independent predictors of improved functional ability over time (P < 0.05). Patients receiving stroke unit care additionally gained 4 BI points within 6 months compared with their counterparts (P = 0.004).


CONCLUSIONS
Functional outcome in the general population showed an increase followed by a plateau. Care parameters reflecting guideline treatment independently improved recovery illustrating the beneficial effects of evidence-based interventions on recovery in an unbiased population.
Toschke
A M
AM
Division of Health and Social Care Research, King's College London, London, UK. michael.toschke@kcl.ac.uk
Tilling
K
K
Cox
A M
AM
Rudd
A G
AG
Heuschmann
P U
PU
Wolfe
C D A
CD
D000203:Activities of Daily Living; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D008131:London; D008297:Male; D008875:Middle Aged; D015233:Models, Statistical; D015999:Multivariate Analysis; D020127:Recovery of Function; D012042:Registries; D020521:Stroke / Q000401:mortality / Q000628:therapy*; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult