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Prestroke Rehabilitation Reserve and Mobility and Self-Care Outcomes After Incident Stroke Across Four International
Ce Shi1, Lihua Wu2, Weiwei Wu3
1The First Clinical Medical College of Anhui University of Chinese Medicine, Hefei, Anhui.
Objective:
To examine whether lower multidimensional prestroke rehabilitation reserve was associated with adverse mobility/self-care status after incident stroke.
Design:
Harmonized longitudinal cohort study.
Setting:
Population-based aging cohorts in China, the United States, England, and continental Europe.
Participants:
Adults who were stroke-free at the prestroke assessment and reported an incident stroke at follow-up (descriptive sample, N=7486; mean age, 70.0y [SD, 10.2]). The first interview reporting stroke typically occurred 2-3 years after the prestroke wave.
Interventions:
Not applicable.
Main Outcome Measures:
Adverse mobility/self-care status, defined as having at least 2 limitations in walking, transferring, dressing, bathing, toileting, or stair climbing at the first interview reporting stroke.
Results:
The adjusted sample included 7429 participants and 2104 events. Each 1-SD lower cohort-standardized prestroke rehabilitation reserve score was associated with 27.7% higher risk (risk ratio, 1.277; 95% confidence interval [CI], 1.230-1.327). Adjusted risks were 20.6%, 26.0%, and 37.4% for high, intermediate, and low reserve, respectively; the adjusted low-vs-high risk difference was 16.8 percentage points (95% CI, 14.0-19.7). Results were consistent across cohorts and functional-overlap sensitivity analyses. The cohorts lacked harmonized National Institutes of Health Stroke Scale scores, acute treatment, and rehabilitation dose.
Conclusions:
Lower prestroke reserve was associated with a higher subsequent mobility/self-care burden. The score may describe group-level vulnerability but is not an individual prediction or treatment-allocation tool. Future studies should test whether prevention or prehabilitation strategies targeting modifiable reserve domains can reduce poststroke disability.
