Functional Outcomes and Long-term Survival in Patients After Stroke Rehabilitation
Date Issued
2004
Date
2004
Author(s)
Chen, Ssu-Yuan
DOI
en-US
Abstract
Background and Objectives: The effect of functional outcomes after rehabilitation on the long-term survival of patients with stroke is unclear. The aims of the study are to explore the predictors of functional outcomes after rehabilitation, and to determine the effect of functional outcomes after rehabilitation on long-term survival in patients with stroke. The functional outcomes of interest in the study are the patient’s walking ability and tube feeding dependency due to stroke-related dysphagia after rehabilitation.
Materials and Methods: Part I: A cohort of 590 patients, aged 45 years and older, admitted for inpatient stroke rehabilitation from 1990 to 1995 was constructed. The walking ability of patients after rehabilitation was classified as either adequate or poor based on chart records. Cox proportional hazards regression analysis was used to identify independent predictors of survival until the end of 2000. Part II: A cohort of 182 patients with stroke-related dysphagia referred for videofluoroscopic swallowing study (VSS) from 1994 to 1999 was constructed. VSS findings and clinical features in the post-acute phase of stroke were recorded. Cox proportional hazards regression analysis was used to identify independent predictors of survival until the end of 2000. Part III: A total of 181 tube-fed inpatients referred for VSS from 1994 to 1999 due to stroke-related dysphagia were enrolled. Multivariate logistic regression analysis was used to identify independent predictors of tube feeding dependency at discharge.
Results: Part I: In the median follow-up time of 71.1 months after discharge, poor walking ability was independently associated with long-term survival, with a hazard ratio (HR) of 2.01 (95% confidence intervals (CI) = 1.55-2.61). The associations of increasing age with poor long-term survival and poor walking ability after stroke rehabilitation were observed in the older group (age ≥ 65), but not in the middle-aged group (age 45-64). Part II: In the median follow-up time of 30.8 months after VSS, advanced age (HR = 1.46, 95% CI = 1.13-1.89, every 10 years of increase), recurrent stroke (HR = 1.74, 95% CI = 1.06-2.85), the need of tube-feeding (HR = 2.07, 95% CI = 1.19-3.59), and being wheelchair-confined (HR = 2.83, 95% CI = 1.54-5.19) during follow-up were independent predictors of long-term survival. Part III: Advanced age (Odds ratio (OR) = 1.07, 95% CI = 1.02-1.12, every 1 year of increase), recurrent stroke (OR = 2.85, 95% CI = 1.15-7.07), wheelchair-confined at discharge (OR = 8.54, 95% CI = 3.29-22.15), long duration from stroke onset to VSS (OR = 1.02, 95% CI = 1.01-1.04, every 1 day of increase), and findings of VSS (stasis in valleculae or pyriform sinus, and aspiration) were independently associated with tube feeding dependency at discharge. Based on the final regression model, a preliminary equation was proposed to help clinicians better predict the tube feeding dependency at discharge in stroke patients with dysphagia.
Conclusions: The patient’s walking ability after inpatient rehabilitation independently predicts long-term survival in patients with stroke. Tube feeding dependency independently predicts long-term survival in stroke patients with dysphagia. VSS-detected aspiration during the post-acute phase of stroke was not predictive for the long-term survival in stroke patients with dysphagia. However, findings of VSS are associated with tube feeding dependency at discharge in stroke patients with dysphagia. The functional outcomes after rehabilitation, such as walking ability and tube feeding dependency, predict long-term survival of patients with stroke. Stroke rehabilitation not only adds quality of life but also improves long-term survival of patients with stroke.
Subjects
功能預後
存活分析
步行能力
吸入現象
吞嚥困難
腦中風復健
管灌飲食
電視螢光錄影吞嚥檢查
functional outcome
dysphagia
stroke rehabilitation
walking ability
survival analysis
tube feeding
videofluoroscopy
aspiration
Type
thesis
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