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Clinical Equations Predict Community Participation at 3 and 6 Months After Stroke: A Cohort Study
Thaciany Correia1, Elizângela Kuster, Letícia Ventura
1Department of Physiotherapy, CAMINHAR Lab, Center of Health Sciences, Post-graduate program in Physiological Sciences, Universidade Federal do Espírito Santo, Vitória, Brazil (T.C., E.K., L.V., L.R.N.); and Department of Collective Health, Universidade Federal de Juiz de Fora, Juiz de Fora, Brazil (S.S.).
Background And Purpose:
Individuals after stroke experience participation restrictions. The purpose of this study was to investigate whether measures collected early after stroke predict participation at 3 and 6 months and develop clinical prediction equations.
Methods:
A prospective cohort study was conducted. Adults were initially assessed in person at the hospital (<7 days), followed by phone interviews at 28 days, 3, and 6 months. The outcome of interest was participation, measured using the Stroke Impact Scale Participation Subscale. Predictors were prestroke (age, activity/participation, environmental factors, and mobility) and poststroke factors (mobility, cognition, depression, functional independence, social support, and self-efficacy).
Results:
A total of 251 participants (129 men) were included. The equation to predict participation at 3 months (P-3) explained 26% of the variance: P-3: Participation (y) = 25.10 - (5.81 × Modified Rankin Scale) + (1.20 × stroke self-efficacy) (R2 = 0.26). Its predictive performance showed a moderate positive predictive value (54%; 95% confidence interval [CI], 0.39-0.68) and a high negative predictive value (83%; 95% CI, 0.52-0.98). The equation to predict participation at 6 months (P-6) explained 48% of the variance: P-6: Participation (y) = 64.04 + (0.29 × Stroke Impact Scale _baseline) - (4.33 × Modified Rankin Scale) - (1.40 × Mini-Mental) + (0.21 × life-space assessment) (R2 = 0.48). The positive predictive value was moderate (55%; 95% CI, 0.40-0.68), and the negative predictive value was high (100%; 95% CI, 0.59-1.00).
Discussion And Conclusions:
This study provided simple equations that predict participation at 3 and 6 months after stroke, based on data collected early after stroke.
