Late functional improvement and 5-year poststroke outcomes: a population-based cohort study

Area of Science:

• Neurology
• Rehabilitation Medicine
• Health Economics

Background:

• Late functional improvement occurs in approximately 28% of ischemic stroke survivors between 3 and 12 months post-stroke.
• This late recovery is more prevalent in lacunar strokes.
• The long-term clinical and health economic implications of this late improvement remain largely unknown.

Purpose of the Study:

• To investigate the association between late functional improvement and long-term outcomes in ischemic stroke survivors.
• To examine the impact of late recovery on 5-year mortality, institutionalization, and healthcare costs.

Main Methods:

• Prospective, population-based cohort study of 1-year ischemic stroke survivors (Oxford Vascular Study).
• Functional status assessed using modified Rankin Scale (mRS), Rivermead Mobility Index (RMI), and Barthel Index (BI) at 3 and 12 months.
• Cox regressions and generalized linear models used to analyze associations with 5-year outcomes and costs, adjusted for relevant covariates.

Main Results:

• Late functional improvement (defined by mRS, RMI, and/or BI changes) was observed in 28.1% of eligible survivors.
• Late improvers showed significantly lower 5-year mortality (aHR 0.68) and institutionalization rates (aHR 0.48).
• Associated with reduced 5-year healthcare and social care costs (US$17,524 reduction).

Conclusions:

• Late functional improvement post-stroke is a significant predictor of better long-term clinical and economic outcomes.
• Findings support efforts to maximize late recovery through continued or extended rehabilitation therapies.
• Motivates clinicians and patients to focus on optimizing recovery throughout the first year post-stroke.