This is great but by this time insurance has probably cut off paying for therapy. Plateau, you know. So unless there are publicly available protocols this knowledge is totally useless.
Late functional improvement and 5-year poststroke outcomes: a population-based cohort study
Author affiliations
Abstract
Background
Late functional improvement between 3 and 12 months post stroke occurs
in about one in four patients with ischaemic stroke, more commonly in
lacunar strokes. It is unknown whether this late improvement is
associated with better long-term clinical or health economic outcomes.
Methods
In a prospective, population-based cohort of 1-year ischaemic stroke
survivors (Oxford Vascular Study; 2002–2014), we examined changes in
functional status (modified Rankin Scale (mRS), Rivermead Mobility Index
(RMI), Barthel Index (BI)) from 3 to 12 months poststroke. We used Cox
regressions adjusted for age, sex, 3-month disability and stroke subtype
(lacunar vs non-lacunar) to examine the association of late improvement
(by ≥1 mRS grades, ≥1 RMI points and/or ≥2 BI points between 3 and 12
months) with 5-year mortality and institutionalisation. We used
similarly adjusted generalised linear models to examine association with
5-year healthcare/social-care costs.
Results
Among 1288 one-year survivors, 1135 (88.1%) had 3-month mRS >0, of
whom 319 (28.1%) demonstrated late functional improvement between 3 and
12 months poststroke. Late improvers had lower 5-year mortality (aHR per
mRS=0.68, 95% CI 0.51 to 0.91, p=0.009), institutionalisation (aHR
0.48, 0.33 to 0.72, p<0.001) and healthcare/social care costs (margin
US$17 524, –24 763 to −10 284, p<0.001). These associations remained
on excluding patients with recurrent strokes during follow-up (eg,
5-year mortality/institutionalisation: aHR 0.59, 0.44 to 0.79,
p<0.001) and on examining late improvement per RMI and/or BI (eg,
5-year mortality/institutionalisation with RMI/BI: aHR 0.73, 0.58 to
0.92, p=0.008).
Conclusion
Late functional improvement post stroke is associated with lower 5-year
mortality, institutionalisation rates and healthcare/social care costs.
These findings should motivate patients and clinicians to maximise late
recovery in routine practice, and to consider extending access to proven
rehabilitative therapies during the first year post stroke.
https://creativecommons.org/licenses/by/4.0/
This
is an open access article distributed in accordance with the Creative
Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits
others to copy, redistribute, remix, transform and build upon this work
for any purpose, provided the original work is properly cited, a link to
the licence is given, and indication of whether changes were made.
See: https://creativecommons.org/licenses/by/4.0/.
No comments:
Post a Comment