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Five-year mortality and related prognostic factors after inpatient rehabilitation: a European multi-centre study
Tijdschriftbijdrage - Tijdschriftartikel
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.
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.
Tijdschrift: J Rehabil Med
ISSN: 1650-1977
Volume: 44
Pagina's: 547-552
Jaar van publicatie:2012
Trefwoorden:stroke, follow-up study, rehabilitation, prognosis, mortality