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Title: Five-year mortality and related prognostic factors after inpatient stroke rehabilitation: A European multi-centre study
Authors: De Wit, Liesbet
Putman, Koen
Devos, Hannes
Brinkmann, Nadine
Dejaeger, Eddy
De Weerdt, Willy
Jenni, Walter
Lincoln, Nadina
Schuback, Birgit
Schupp, Wilfried
LESAFFRE, Emmanuel 
Issue Date: 2012
Abstract: Objective: To determine 5-year mortality and its association with baseline characteristics and functional status 6 months post-stroke for patients who received inpatient rehabilitation. Design: A prospective rehabilitation-based cohort study. Subjects: A total of 532 consecutive stroke patients from 4 European rehabilitation centres. Methods: Predictors were recorded on admission. Barthel Index was assessed at 6 months (BI6mths) and patients were followed for 5 years post-stroke. Survival probability was computed using Kaplan-Meier analysis and compared across 3 BI6mths-classes (0-60, 65-90, 95-100) (log-rank test). Significant independent predictors were determined using multivariate Cox regression analysis (hazard ratio (HR)). Results: Five-year cumulative risk of death was 29.12% (95% confidence interval (CI): 22.86-35.38). Age (HR= 1.06, 95% CI: 1.04-1.09), cognitive impairment (HR= 1.77, 95% CI: 1.21-2.57), diabetes mellitus (HR= 1.68, 95% CI: 1.16-2.41) and atrial fibrillation (HR= 1.52, 95% CI: 1.08-2.14) were independent predictors of increased mortality. Hyperlipidaemia (HR=0.66, 95% CI: 0.46-0.94), and higher BI6mths (HR=0.98, 95% CI: 0.97-0.99) were independent predictors of decreased mortality. Five-year survival probability was 0.85(95% CI: 0.80-0.89) for patients in BI6mthsclass: 95-100, 0.72 (95% CI: 0.63-0.79) in BI6mths-class: 65-90 and 0.50 (95% CI: 0.40-0.60) in BI6mths-class: 0-60 (p<0.0001). Conclusion: Nearly one-third of rehabilitation patients died during the first 5 years following stroke. Functional status at 6 months was a powerful predictor of long-term mortality. Maximum functional independence at 6 months post-stroke should be promoted through medical interventions and rehabilitation. Future studies are recommended to evaluate the direct effect of rehabilitation on long-term survival.
Notes: [De Wit, Liesbet; Putman, Koen] Vrije Univ Brussel, Dept Med Sociol & Hlth Sci, Fac Med & Pharm, BE-1090 Brussels, Belgium. [De Wit, Liesbet; Devos, Hannes; De Weerdt, Willy] Katholieke Univ Leuven, Dept Rehabil Sci, Fac Kinesiol & Rehabil Sci, B-3001 Heverlee, Belgium. [Brinkmann, Nadine; Schupp, Wilfried] Fachklin Herzogenaurach, Herzogenaurach, Germany. [Dejaeger, Eddy] Univ Hosp Pellenberg, Pellenberg, Belgium. [Jenni, Walter; Schuback, Birgit] RehaClin Zurzach, Bad Zurzach, Switzerland. [Lincoln, Nadina] Univ Nottingham, Inst Work Hlth & Org, Nottingham NG7 2RD, England. [Lesaffre, Emmanuel] Katholieke Univ Leuven, L BioStat, Louvain, Belgium. [Lesaffre, Emmanuel] Univ Hasselt, Louvain, Belgium. [Lesaffre, Emmanuel] Erasmus MC, Dept Biostat, Rotterdam, Netherlands.
Keywords: Rehabilitation; Sport Sciences; follow-up study; stroke; rehabilitation; prognosis; mortality;follow-up study; stroke; rehabilitation; prognosis; mortality
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ISSN: 1650-1977
e-ISSN: 1651-2081
DOI: 10.2340/16501977-0991
ISI #: 000305814900005
Category: A1
Type: Journal Contribution
Validations: ecoom 2013
Appears in Collections:Research publications

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