Prognostic factors for ambulation and activities of daily living in the subacute phase after stroke. A systematic review of the literature.

Abstract

OBJECTIVE:

To identify evidence-based prognostic factors in the subacute phase after stroke for activities of daily living (ADL) and ambulation at six months to one year after stroke.

DESIGN:

Systematic literature search designed in accordance with the Cochrane Collaboration criteria with the following data sources: (1) MEDLINE, EMBASE, CINAHL, Current Contents, Cochrane Database of Systematic Reviews, Psyclit, and Sociological Abstracts. (2) Reference lists, personal archives, and consultation of experts. (3) Guidelines.

METHODS:

Inclusion criteria were: (1) cohort studies of patients with an ischaemic or haemorrhagic stroke; (2) inception cohort with assessment of prognostic factors within the first two weeks after stroke; (3) outcome measures for ADL and ambulation; and (4) a follow-up of six months to one year. Internal, statistical and external validity of the studies were assessed using a checklist with 11 methodological criteria in accordance with the recommendations of the Cochrane Collaboration.

RESULTS:

From 1,027 potentially relevant studies 26 studies involving a total of 7,850 patients met the inclusion criteria. Incontinence for urine is the only prognostic factor identified in three studies with a level A (i.e., a good level of scientific evidence according to the methodological score). The following factors were found in one level A study: initial ADL disability and ambulation, high age, severe paresis or paralysis, impaired swallowing, ideomotor apraxia, ideational apraxia, and visuospatial construction problems; as well as factors relating to complications of an ischaemic stroke, such as extraparenchymal bleeding, cerebral oedema and size of intraparenchymal haemorrhage.

CONCLUSIONS:

The present evidence concerning possible predictors in the subacute stage of stroke has insufficient quality to make an evidence-based prediction of ADL and ambulation after stroke because only one prognostic factor was demonstrated in at least two level A studies, our cut-off for sufficient scientific evidence.

• Authors: R Meijer, D S Ihnenfeldt, I J M de Groot, J van Limbeek, M Vermeulen, R J de Haan
• Journal: Clinical rehabilitation (Clin Rehabil) Vol. 17 Issue 2 Pg. 119-29 (Mar 2003) ISSN: 0269-2155 [Print] England
• PMID: 12625651 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't, Review, Systematic Review)

Topics

• Activities of Daily Living
• Acute Disease
• Evidence-Based Medicine
• Humans
• Movement (physiology)
• Prognosis
• Recovery of Function (physiology)
• Reproducibility of Results
• Stroke (physiopathology)
• Stroke Rehabilitation