Changes in functional outcome after a first-time stroke: Data from a longitudinal study

Abstract

Background Strokes are the major cause of disability. Functional recovery following an acute stroke is time-dependent and varies depending on several factors. This study aimed to investigate changes in functional outcomes after stroke from discharge to six months post-discharge and to identify factors associated with changes in functional outcomes during this six-month period. Methods The study included 155 consecutive patients with a first stroke and were hospitalized in an acute stroke unit at an advanced tertiary hospital in Bangkok between April 2020 and August 2021. The patients’ functional outcomes were evaluated using the modified Rankin Scale (mRS) and the Barthel Index (BI) before hospital discharge and at one-, three-, and six-month post-discharge. Friedman tests were used to assess changes in mRS scores over six months. Linear mixed effect regression was applied to identify the change in BI scores during the six months post-discharge. Results Of the participants, 62.6% were men, and the mean age was 64.0 (SD = 12.5). The median mRS scores ranged from 3.0 at discharge to 0.0 at six months post-discharge. Significant changes in mRS scores were identified within three months post-discharge, and differences by stroke subtype and severity (P < 0.05). The crude BI means ranged from 70.6 (SD = 28.5) at discharge to 93.1 (SD = 20.4) at six months post-discharge. Female participants and those with hemorrhagic strokes had lower adjusted BI scores compared to male participants and those with ischemic strokes, with differences of 4.1 and 4.5 points, respectively. Additionally, stroke severity was inversely related to adjusted BI scores. One increased National Institute of Health Stroke Scale (NIHSS) score decreased adjusted BI scores by 3.6. Conclusion The time after discharge, gender, stroke subtype, and stroke severity are significant factors affecting functional outcomes after a stroke. The most significant improvement in functional outcomes occurred within one month post-discharge.