2.50
Hdl Handle:
http://hdl.handle.net/10755/151849
Type:
Presentation
Title:
The Trajectory of Functional Recovery over Twelve Months Following Stroke
Abstract:
The Trajectory of Functional Recovery over Twelve Months Following Stroke
Conference Sponsor:Sigma Theta Tau International
Conference Year:2002
Conference Date:July, 2002
Author:Shaughnessy, Marianne
P.I. Institution Name:University of Maryland
Title:Assistant Professor
Objective: Stroke is the most common life threatening neurological disorder in the U.S., affecting roughly 730,000 people each year. This secondary analysis of a dataset generated by Whitney and colleagues sought to describe individual trajectories of recovery following stroke, and identify variables associated with functional decline and recovery over twelve months. Design: This observational study surveyed stroke survivors periodically regarding aspects of their health and function throughout their first year of recovery. Population & Setting: Three hundred stroke survivors were enrolled in the parent study, and those who completed data collection to one year (N=173) were considered in this analysis. Participants were surveyed in the hospital at the time of their strokes and at home three, six and twelve months later. Standardized, validated instruments were used to measure neurological and cognitive status, depression status and functional ability. Demographic data (age, gender, race, marital status, laterality of lesion) was also considered in this analysis. Sample: In this sample of 173 stroke survivors, gender, race and laterality were equally distributed. The age range of the sample was 31-94 with a mean of 68, and 76.4% over the age of 60, producing a skewed distribution toward elders, which is reflective of the stroke population in general. Concepts Studied: The trajectories of recovery following a sudden onset disability in an elderly population within the context of comorbid illnesses such as depression and cognitive dysfunction. Methods: Potential subjects with a diagnosis of stroke were enrolled within 30 days of the onset of acute symptoms. Confirmation of the diagnosis was obtained with CT scans. Research assistants trained in the administration of the study instruments collected all study data. Interviews with participants were conducted at the bedside and in their homes following discharge from the hospital. Findings: Graphical analysis of individual trajectories indicated that recovery was highly variable. Following a nearly universal increase in functional status over the first three months, many subjects experienced varying degrees of functional decline. Unadjusted and pairwise analyses of each of the independent variables compared to functional decline revealed a significant relationship between the functional outcomes of those who developed depression during recovery as compared to a) those who never became depressed (p=0.0048), and b) those whose depression had resolved (p=0.028). An effort to develop an association model for patients who declined functionally using logistic regression analysis removed all independent variables, including age. However, the same analysis performed examining those who achieved full functional recovery yielded a model that showed neurological status and functional status scores at three months post stroke were highly associated with full recovery (-2 Log L=126.080; c=0.864). Conclusions: While most subjects experienced a dramatic increase in function in the first three months following stroke, many also suffered a subsequent decline. The slopes of these declines were highly variable, and correlated to new onset depression. Age was not found to be associated with functional decline, as opposed to common belief. Subjects who were younger, had social support or had higher functional status or neurological status scores at three months were more likely to achieve full functional recovery. Implications: Trajectory analysis is a novel way of describing changes over time and the influence of covariates in a chronically ill population. Identifying influences that optimize functional recovery following stroke should continue to be a priority for researchers. Continued study using qualitative methods may provide stroke researchers with a better understanding of this process.

Repository Posting Date:
26-Oct-2011
Date of Publication:
Jul-2002
Sponsors:
Sigma Theta Tau International

Full metadata record

DC FieldValue Language
dc.typePresentationen_GB
dc.titleThe Trajectory of Functional Recovery over Twelve Months Following Strokeen_GB
dc.identifier.urihttp://hdl.handle.net/10755/151849-
dc.description.abstract<table><tr><td colspan="2" class="item-title">The Trajectory of Functional Recovery over Twelve Months Following Stroke</td></tr><tr class="item-sponsor"><td class="label">Conference Sponsor:</td><td class="value">Sigma Theta Tau International</td></tr><tr class="item-year"><td class="label">Conference Year:</td><td class="value">2002</td></tr><tr class="item-conference-date"><td class="label">Conference Date:</td><td class="value">July, 2002</td></tr><tr class="item-author"><td class="label">Author:</td><td class="value">Shaughnessy, Marianne</td></tr><tr class="item-institute"><td class="label">P.I. Institution Name:</td><td class="value">University of Maryland</td></tr><tr class="item-author-title"><td class="label">Title:</td><td class="value">Assistant Professor</td></tr><tr class="item-email"><td class="label">Email:</td><td class="value">shaughne@son.umaryland.edu</td></tr><tr><td colspan="2" class="item-abstract">Objective: Stroke is the most common life threatening neurological disorder in the U.S., affecting roughly 730,000 people each year. This secondary analysis of a dataset generated by Whitney and colleagues sought to describe individual trajectories of recovery following stroke, and identify variables associated with functional decline and recovery over twelve months. Design: This observational study surveyed stroke survivors periodically regarding aspects of their health and function throughout their first year of recovery. Population &amp; Setting: Three hundred stroke survivors were enrolled in the parent study, and those who completed data collection to one year (N=173) were considered in this analysis. Participants were surveyed in the hospital at the time of their strokes and at home three, six and twelve months later. Standardized, validated instruments were used to measure neurological and cognitive status, depression status and functional ability. Demographic data (age, gender, race, marital status, laterality of lesion) was also considered in this analysis. Sample: In this sample of 173 stroke survivors, gender, race and laterality were equally distributed. The age range of the sample was 31-94 with a mean of 68, and 76.4% over the age of 60, producing a skewed distribution toward elders, which is reflective of the stroke population in general. Concepts Studied: The trajectories of recovery following a sudden onset disability in an elderly population within the context of comorbid illnesses such as depression and cognitive dysfunction. Methods: Potential subjects with a diagnosis of stroke were enrolled within 30 days of the onset of acute symptoms. Confirmation of the diagnosis was obtained with CT scans. Research assistants trained in the administration of the study instruments collected all study data. Interviews with participants were conducted at the bedside and in their homes following discharge from the hospital. Findings: Graphical analysis of individual trajectories indicated that recovery was highly variable. Following a nearly universal increase in functional status over the first three months, many subjects experienced varying degrees of functional decline. Unadjusted and pairwise analyses of each of the independent variables compared to functional decline revealed a significant relationship between the functional outcomes of those who developed depression during recovery as compared to a) those who never became depressed (p=0.0048), and b) those whose depression had resolved (p=0.028). An effort to develop an association model for patients who declined functionally using logistic regression analysis removed all independent variables, including age. However, the same analysis performed examining those who achieved full functional recovery yielded a model that showed neurological status and functional status scores at three months post stroke were highly associated with full recovery (-2 Log L=126.080; c=0.864). Conclusions: While most subjects experienced a dramatic increase in function in the first three months following stroke, many also suffered a subsequent decline. The slopes of these declines were highly variable, and correlated to new onset depression. Age was not found to be associated with functional decline, as opposed to common belief. Subjects who were younger, had social support or had higher functional status or neurological status scores at three months were more likely to achieve full functional recovery. Implications: Trajectory analysis is a novel way of describing changes over time and the influence of covariates in a chronically ill population. Identifying influences that optimize functional recovery following stroke should continue to be a priority for researchers. Continued study using qualitative methods may provide stroke researchers with a better understanding of this process.<br/><br/></td></tr></table>en_GB
dc.date.available2011-10-26T11:15:45Z-
dc.date.issued2002-07en_GB
dc.date.accessioned2011-10-26T11:15:45Z-
dc.description.sponsorshipSigma Theta Tau Internationalen_GB
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