A new method for predicting recovery after stroke

Kate Tilling, Jonathan A C Sterne, Anthony G. Rudd, Thomas A. Glass, Robert J. Wityk, Charles D A Wolfe

Research output: Contribution to journalArticle

Abstract

Background and Purpose - Several prognostic factors have been identified for outcome after stroke. However, there is a need for empirically derived models that can predict outcome and assist in medical management during rehabilitation. To be useful, these models should take into account early changes in recovery and individual patient characteristics. We present such a model and demonstrate its clinical utility. Methods - Data on functional recovery (Barthel Index) at 0, 2, 4, 6, and 12 months after stroke were collected prospectively for 299 stroke patients at 2 London hospitals. Multilevel models were used to model recovery trajectories, allowing for day-to-day and between-patient variation. The predictive performance of the model was validated with an independent cohort of 710 stroke patients. Results - Urinary incontinence, sex, prestroke disability, and dysarthria affected the level of outcome after stroke; age, dysphasia, and limb deficit also affected the rate of recovery. Applying this to the validation cohort, the average difference between predicted and observed Barthel Index was -0.4, with 90% limits of agreement from -7 to 6. Predicted Barthel Index lay within 3 points of the observed Barthel Index on 49% of occasions and improved to 69% when patients' recovery histories were taken into account. Conclusions - The model predicts recovery at various stages of rehabilitation in ways that could improve clinical decision making. Predictions can be altered in light of observed recovery. This model is a potentially useful tool for comparing individual patients with average recovery trajectories. Patients at elevated risk could be identified and interventions initiated.

Original languageEnglish (US)
Pages (from-to)2867-2873
Number of pages7
JournalStroke
Volume32
Issue number12
StatePublished - 2001

Fingerprint

Stroke
Rehabilitation
Dysarthria
Aphasia
Urinary Incontinence
Extremities

Keywords

  • Activities of daily living
  • Disability evaluation
  • Models, statistical
  • Prognosis
  • Recovery of function

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Neuroscience(all)

Cite this

Tilling, K., Sterne, J. A. C., Rudd, A. G., Glass, T. A., Wityk, R. J., & Wolfe, C. D. A. (2001). A new method for predicting recovery after stroke. Stroke, 32(12), 2867-2873.

A new method for predicting recovery after stroke. / Tilling, Kate; Sterne, Jonathan A C; Rudd, Anthony G.; Glass, Thomas A.; Wityk, Robert J.; Wolfe, Charles D A.

In: Stroke, Vol. 32, No. 12, 2001, p. 2867-2873.

Research output: Contribution to journalArticle

Tilling, K, Sterne, JAC, Rudd, AG, Glass, TA, Wityk, RJ & Wolfe, CDA 2001, 'A new method for predicting recovery after stroke', Stroke, vol. 32, no. 12, pp. 2867-2873.
Tilling K, Sterne JAC, Rudd AG, Glass TA, Wityk RJ, Wolfe CDA. A new method for predicting recovery after stroke. Stroke. 2001;32(12):2867-2873.
Tilling, Kate ; Sterne, Jonathan A C ; Rudd, Anthony G. ; Glass, Thomas A. ; Wityk, Robert J. ; Wolfe, Charles D A. / A new method for predicting recovery after stroke. In: Stroke. 2001 ; Vol. 32, No. 12. pp. 2867-2873.
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