title: Early prediction of outcome of activities of daily living after stroke: a systematic review.
abstract: OBJECTIVE
  Knowledge about robust and unbiased factors that predict outcome of activities of daily living (ADL) is paramount in stroke management. This review investigates the methodological quality of prognostic studies in the early poststroke phase for final ADL to identify variables that are predictive or not predictive for outcome of ADL after stroke.
  
  
  METHODS
  PubMed, Ebsco/Cinahl and Embase were systematically searched for prognostic studies in which stroke patients were included ≤2 weeks after onset and final outcome of ADL was determined ≥3 months poststroke. Risk of bias scores were used to distinguish high- and low-quality studies and a qualitative synthesis was performed.
  
  
  RESULTS
  Forty-eight of 8425 identified citations were included. The median risk of bias score was 17 out of 27 (range, 6-22) points. Most studies failed to report medical treatment applied, management of missing data, rationale for candidate determinants and outcome cut-offs, results of univariable analysis, and validation and performance of the model, making the predictive value of most determinants indistinct. Six high-quality studies showed strong evidence for baseline neurological status, upper limb paresis, and age as predictors for outcome of ADL. Gender and risk factors such as atrial fibrillation were unrelated to this outcome.
  
  
  CONCLUSIONS
  Because of insufficient methodological quality of most prognostic studies, the predictive value of many clinical determinants for outcome of ADL remains unclear. Future cohort studies should focus on early prediction using simple models with good clinical performance to enhance application in stroke management and research.
authors.affiliation: Department of Rehabilitation Medicine, Research Institute MOVE, Room -1Y.172.06, VU University Medical Center, PO Box 7057, De Boelelaan 1117, 1007 MB Amsterdam, the Netherlands.
authors.forename: Janne M
authors.initials: JM
authors.lastname: Veerbeek
authors.forename: Gert
authors.initials: G
authors.lastname: Kwakkel
authors.forename: Erwin E H
authors.initials: EE
authors.lastname: van Wegen
authors.forename: Johannes C F
authors.initials: JC
authors.lastname: Ket
authors.forename: Martijn W
authors.initials: MW
authors.lastname: Heymans
mesh_terms: D000203:Activities of Daily Living; D006801:Humans; D008962:Models, Theoretical; D011379:Prognosis; D020521:Stroke / Q000175:diagnosis*; D000071939:Stroke Rehabilitation