Article

PURPOSE: To develop prognostic models and equations for predicting participation
at six months after stroke. METHODS: This European prospective cohort study
recruited 532 consecutive patients from four rehabilitation centers.
Participation was assessed at six months after stroke with the Sickness Impact
Profile (SIP), which consists of a physical, psychosocial and independent
dimension. Twenty-six independent variables on admission to the rehabilitation
center and 13 additional variables measured at two months post stroke were
included in the analysis. A multiple logistic regression analysis was conducted
predicting good participation (SIP < 20%). Sensitivity, specificity, positive and
negative predictive values were calculated. RESULTS: The prognostic models for
the three dimensions provided independent predictors containing demographics,
complications, diagnostic, and disability measures. Sensitivity ranged from
64-84%, specificity 66-85%, positive predictive value 70-78%, and negative
predictive value 76-87%. Barthel Index on admission, Euroqol Health State at two
months and Caregiver Strain Index at two months were retained in all prediction
models. CONCLUSIONS: A combination of variables was found in the prognostic
models of the three dimensions of the SIP at six months after stroke. Already
from the early beginning of stroke rehabilitation it seems important to focus on
personal activities of daily living as well as caregivers' strain. IMPLICATIONS
FOR REHABILITATION: Prognostic factors predicting participation, measured by the
three dimensions of the Sickness Impact Profile at six months post stroke include
demographic variables, post-stroke complications, diagnostic parameters and
disability measures. Significant prognostic variables for all three dimensions of
the Sickness Impact Profile were a higher Barthel Index score on admission to the
rehabilitation center, a higher Euroqol Health State score at two months post
stroke and a lower Caregiver Strain Index score at two months post stroke. Early
stroke therapy should therefore further emphasize rehabilitation of personal
activities of daily living such as mobility, walking, feeding, dressing, and
toilet use, as well as considering strategies to reduce caregiver strain such as
giving support, providing information and training carers.

Langue : ANGLAIS