Abstract
This thesis is based on findings of the Functional Prognostication and disability study on stroke, which had two main objectives: (1) to examine which outcome measures are most appropriate, and especially most responsive, for the assessment of functional outcome in stroke patients and (2) to study prognostic determinants of functional
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outcome and recovery after stroke. A total of 308 patients with a first-ever stroke were followed from admission to the rehabilitation center up to one year post stroke. We concluded that the Barthel Index, Functional Independence Measure total and motor score, Frenchay Activities Index (FAI) and Stroke-Adapted Sickness Impact Profile 30 (SASIP30) were all responsive measures. We recommend the use of the Barthel Index for the period until 6 months post stroke and the use of the FAI and SASIP30 for the period 6 months until one year post stroke. The ICF proved to be a useful tool to compare contents of instruments in stroke rehabilitation. The content of several known functional outcome measures that are frequently used in stroke rehabilitation were examined by linking the items to the International Classification of Functioning, Disability and Health (ICF). Most items fitted into the activities and participation component, with mobility being the category most frequently covered in the instruments. This content comparison enables professionals to choose the measure that best matches the area of their interest. We developed a prediction rule that could identify, at admission, patients at risk for social inactivity 1 year post stroke. Older patients, males, patients living with a partner, and patients with more problems with motor function, with communication and with ADL independence were more at risk for social inactivity 1 year post stroke. An easy-to-use score chart allows the identification of patients at risk and enables professionals to focus early on the social activity of this subgroup. Fatigue is an important post-stroke sequela. At admission, 6 months and 1 year post stroke, fatigue was present in 51%, 64% and 69% of the patients respectively. Fatigue impact 1 year post stroke was greater among patients with more depressive symptoms, higher age, females and patients with a locus of control more directed to powerful others. As fatigue impact is an increasing problem during the first year post stroke, it deserves more attention in clinical practice and scientific research. Functional recovery differed between patients with a cerebral infarction (CI) and patients with an intracerebral hemorrhage (ICH) , in terms of the development of independence in Activities of Dailly Living (ADL) over the first year post stroke. From their admission to the rehabilitation center until 12 weeks post stroke, recovery tended to be more rapid for ICH patients than for CI patients. From 12 to 26 weeks post stroke, CI patients showed a significantly faster recovery. The time window for recovery of ADL independence was more restricted for ICH patients ( until 10 weeks post stroke) than for CI patients (until 26 weeks post stroke). These differences should be taken into consideration in stroke management.
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