title: Functional recovery at 3 months in stroke patients not receiving thrombolytic therapy: the comparison between patients arriving earlier and later than 4.5 hours.
abstract: BACKGROUND
  We aim to study the recovery of functional abilities of stroke patients who did not receive recombinant tissue plasminogen activator (rtPA) after treatment for 3 months comparing patients who arrived at a hospital within 4.5 hours and those who arrived after 4.5 hours of symptom onset. Also, we investigated the predictors of the functional recovery and the quality of life (QOL) at 3 months after stroke.
  
  
  METHODS
  Data were collected by interviewing the stroke patients and caregivers twice on Day 1 and at 3 months after the stroke onset. We collected the demographic data, Modified Rankin Scale (mRS), Barthel Index, National Institutes of Health Stroke Scale (NIHSS), Glasgow Coma Scale (GCS), and World Health Organization Quality of Life-Bref-Thai (WHOQOL-Bref-Thai).
  
  
  RESULTS
  Eighty-eight and 85 patients arrived at a hospital within 4.5 and after 4.5 hours respectively. At 3 months after treatment, the recovery of stroke patients as assessed by mRS, Barthel Index, and the QOL in both groups did not differ significantly (P > .05). Approximately 80% in both groups had good QOL. Both groups of patients had a similar low stroke awareness and knowledge in terms of risk factors (P = .825) and care of stroke patients (P = .562). Four variables that significantly predicted the improvement of the mRS score at 3 months after treatment were age 60 years and younger, premorbid self-care ability, the NIHSS score of 14 or less and Day 1 mRS score.
  
  
  CONCLUSIONS
  Stroke patients arriving at the hospital within and after 4.5 hours of the onset who did not receive the rtPA did not have significant differences in the functional outcomes and quality of life at 3 months. However, the eligibility for rtPA is not known before arriving at the hospital so that the necessity of seeking medical treatment as quickly as possible is still warranted. Increasing effective public awareness regarding stroke risk factors and care should be implemented.
authors.affiliation: Department of Preventive and Social Medicine, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok.
authors.forename: Sujittra
authors.initials: S
authors.lastname: Duangjit
authors.affiliation: Department of Preventive and Social Medicine, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok. Electronic address: siwmp@mahidol.ac.th.
authors.forename: Weerasak
authors.initials: W
authors.lastname: Muangpaisan
authors.affiliation: Division of Neurology, Department of Medicine, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok.
authors.forename: Wattanachai
authors.initials: W
authors.lastname: Chotinaiwattarakul
authors.affiliation: Division of Neurology, Department of Internal Medicine, Faculty of Medicine, Thammasat University, Bangkok.
authors.forename: Pornpatr
authors.initials: P
authors.lastname: Dharmasaroja
mesh_terms: D000203:Activities of Daily Living; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D003365:Costs and Cost Analysis; D003627:Data Interpretation, Statistical; D004651:Employment; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D015600:Glasgow Coma Scale; D006801:Humans; D008297:Male; D008875:Middle Aged; D010291:Paresis / Q000453:epidemiology / Q000209:etiology; D011446:Prospective Studies; D011788:Quality of Life; D020127:Recovery of Function; D012959:Socioeconomic Factors; D020521:Stroke / Q000145:classification / Q000401:mortality / Q000628:therapy*; D015912:Thrombolytic Therapy / Q000706:statistics & numerical data*; D013997:Time Factors; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use
chemical_list: D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator