Five-year mortality and related prognostic factors after inpatient stroke rehabilitation: A European multi-centre study

Liesbet De Wit, Koen Putman, Hannes Devos, Nadine Brinkmann, Eddy Dejaeger, Willy De Weerdt, Walter Jenni, Nadina Lincoln, Birgit Schuback, Wilfried Schupp, Emmanuel Lesaffre

Research output: Contribution to journalArticle

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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.

Original languageEnglish (US)
Pages (from-to)547-552
Number of pages6
JournalJournal of Rehabilitation Medicine
Volume44
Issue number7
DOIs
StatePublished - Sep 13 2012

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Inpatients
Confidence Intervals
Mortality
Rehabilitation
Stroke
Survival
Stroke Rehabilitation
Rehabilitation Centers
Kaplan-Meier Estimate
Hyperlipidemias
Atrial Fibrillation
Diabetes Mellitus
Cohort Studies
Regression Analysis

Keywords

  • Follow-up study
  • Mortality
  • Prognosis
  • Rehabilitation
  • Stroke

ASJC Scopus subject areas

  • Physical Therapy, Sports Therapy and Rehabilitation
  • Rehabilitation

Cite this

Five-year mortality and related prognostic factors after inpatient stroke rehabilitation : A European multi-centre study. / De Wit, Liesbet; Putman, Koen; Devos, Hannes; Brinkmann, Nadine; Dejaeger, Eddy; De Weerdt, Willy; Jenni, Walter; Lincoln, Nadina; Schuback, Birgit; Schupp, Wilfried; Lesaffre, Emmanuel.

In: Journal of Rehabilitation Medicine, Vol. 44, No. 7, 13.09.2012, p. 547-552.

Research output: Contribution to journalArticle

De Wit, L, Putman, K, Devos, H, Brinkmann, N, Dejaeger, E, De Weerdt, W, Jenni, W, Lincoln, N, Schuback, B, Schupp, W & Lesaffre, E 2012, 'Five-year mortality and related prognostic factors after inpatient stroke rehabilitation: A European multi-centre study', Journal of Rehabilitation Medicine, vol. 44, no. 7, pp. 547-552. https://doi.org/10.2340/16501977-0991
De Wit, Liesbet ; Putman, Koen ; Devos, Hannes ; Brinkmann, Nadine ; Dejaeger, Eddy ; De Weerdt, Willy ; Jenni, Walter ; Lincoln, Nadina ; Schuback, Birgit ; Schupp, Wilfried ; Lesaffre, Emmanuel. / Five-year mortality and related prognostic factors after inpatient stroke rehabilitation : A European multi-centre study. In: Journal of Rehabilitation Medicine. 2012 ; Vol. 44, No. 7. pp. 547-552.
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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.",
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T1 - Five-year mortality and related prognostic factors after inpatient stroke rehabilitation

T2 - A European multi-centre study

AU - De Wit, Liesbet

AU - Putman, Koen

AU - Devos, Hannes

AU - Brinkmann, Nadine

AU - Dejaeger, Eddy

AU - De Weerdt, Willy

AU - Jenni, Walter

AU - Lincoln, Nadina

AU - Schuback, Birgit

AU - Schupp, Wilfried

AU - Lesaffre, Emmanuel

PY - 2012/9/13

Y1 - 2012/9/13

N2 - 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.

AB - 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.

KW - Follow-up study

KW - Mortality

KW - Prognosis

KW - Rehabilitation

KW - Stroke

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