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

22 Scopus citations

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 - 2012

Keywords

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

ASJC Scopus subject areas

  • Physical Therapy, Sports Therapy and Rehabilitation
  • Rehabilitation

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    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, 44(7), 547-552. https://doi.org/10.2340/16501977-0991