Predictive value of functional disability scales among stroke survivors: A long-term mortality evaluation in a Brazilian stroke cohort

Ana Cristina G de Goes; Karla A S Souza; Gisela Tunes; Airlane P Alencar; Ana C Varella; Tiffany E Gooden; Gregoy Yh Lip; Itamar S Santos; Paulo A Lotufo; Isabela M Benseñor; Alessandra C Goulart

doi:10.1016/j.jstrokecerebrovasdis.2023.107487

Predictive value of functional disability scales among stroke survivors: A long-term mortality evaluation in a Brazilian stroke cohort

Ana Cristina G de Goes^*, Karla A S Souza, Gisela Tunes, Airlane P Alencar, Ana C Varella, Tiffany E Gooden, Gregoy Yh Lip, Itamar S Santos, Paulo A Lotufo, Isabela M Benseñor, Alessandra C Goulart

^*Corresponding author for this work

Applied Health Research

Research output: Contribution to journal › Article › peer-review

Abstract

OBJECTIVE: To assess the influence of two functional scales- Modified Rankin Scale (m-RS) and Modified Katz Index (m-Katz Index) on long-term mortality in a stroke cohort.

MATERIAL AND METHODS: Among 760 stroke survivors (median age: 66 (IQR:56-75), 56.4 % women) m-Katz Index and m-RS scales applied at 1 and 6 months after stroke, were investigated in relation to 12-years of all-cause mortality. Kaplan-Meier survival curves were computed, and time-varying covariate Cox regression models were fitted to calculate hazard ratios (HRs) with 95 % confidence intervals (CIs) in all sample and by sex. The prognostic ability of the fitted models was computed for each model by six different measures.

RESULTS: After 12 years of follow-up (median survival time: 7.3 years), 311 participants died. Overall survival curves show lower survival rates among those with the highest levels of disability/dependence (all log-rank p-values <0.0001). These findings were confirmed in all regression models for both sexes, particularly in men who had higher levels of dependence on Activities of Daily Living (ADLs) by m-Katz Index and severe disability by m-RS and presented the highest HR of dying (HR: 3.34 (95 %CI: 2.27-4.92) and HR: 4.94 (95 % CI: 3.15-7.75), respectively).

CONCLUSIONS: Both the m-Katz Index and the m-RS scale were good predictors of long-term mortality, which is of importance for guiding the functional rehabilitation of stroke patients. Besides, high levels of disability and dependence were implicated with high mortality risks, regardless of sex.

Original language	English
Article number	107487
Number of pages	7
Journal	Journal of Stroke and Cerebrovascular Diseases
Volume	33
Issue number	1
Early online date	17 Nov 2023
DOIs	https://doi.org/10.1016/j.jstrokecerebrovasdis.2023.107487
Publication status	Published - Jan 2024

Bibliographical note

Grant support:
This study was funded by the Sao Paulo Research Support Foundation of the State of São Paulo (FAPESP) (grant no 18/05512-3) and by the NIHR Global Health Research Group of AF (grant no 17/63/121).

Copyright:
© 2023. Published by Elsevier Inc.

Keywords

Cerebrovascular
Rehabilitation medicine/Physical therapy
Poststroke survival
Epidemiology

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NIHR Global Research Group on Atrial Fibrillation
Lasserson, D., Manaseki-Holland, S., Cheng, K., Moore, D., Jolly, K., Greenfield, S., Jowett, S., Brocklehurst, P., Nirantharakumar, K., Szmigin, I., Kirchhof, P., Gough, R. & Thomas, N.
NIHR CENTRAL COMMISSIONING FACILITY
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de Goes, A. C. G., Souza, K. A. S., Tunes, G., Alencar, A. P., Varella, A. C., Gooden, T. E., Lip, G. Y., Santos, I. S., Lotufo, P. A., Benseñor, I. M., & Goulart, A. C. (2024). Predictive value of functional disability scales among stroke survivors: A long-term mortality evaluation in a Brazilian stroke cohort. Journal of Stroke and Cerebrovascular Diseases, 33(1), Article 107487. https://doi.org/10.1016/j.jstrokecerebrovasdis.2023.107487

@article{65b66ea025434bbd9e4df099ed920903,

title = "Predictive value of functional disability scales among stroke survivors: A long-term mortality evaluation in a Brazilian stroke cohort",

abstract = "OBJECTIVE: To assess the influence of two functional scales- Modified Rankin Scale (m-RS) and Modified Katz Index (m-Katz Index) on long-term mortality in a stroke cohort.MATERIAL AND METHODS: Among 760 stroke survivors (median age: 66 (IQR:56-75), 56.4 % women) m-Katz Index and m-RS scales applied at 1 and 6 months after stroke, were investigated in relation to 12-years of all-cause mortality. Kaplan-Meier survival curves were computed, and time-varying covariate Cox regression models were fitted to calculate hazard ratios (HRs) with 95 % confidence intervals (CIs) in all sample and by sex. The prognostic ability of the fitted models was computed for each model by six different measures.RESULTS: After 12 years of follow-up (median survival time: 7.3 years), 311 participants died. Overall survival curves show lower survival rates among those with the highest levels of disability/dependence (all log-rank p-values <0.0001). These findings were confirmed in all regression models for both sexes, particularly in men who had higher levels of dependence on Activities of Daily Living (ADLs) by m-Katz Index and severe disability by m-RS and presented the highest HR of dying (HR: 3.34 (95 %CI: 2.27-4.92) and HR: 4.94 (95 % CI: 3.15-7.75), respectively).CONCLUSIONS: Both the m-Katz Index and the m-RS scale were good predictors of long-term mortality, which is of importance for guiding the functional rehabilitation of stroke patients. Besides, high levels of disability and dependence were implicated with high mortality risks, regardless of sex.",

keywords = "Cerebrovascular, Rehabilitation medicine/Physical therapy, Poststroke survival, Epidemiology",

author = "{de Goes}, {Ana Cristina G} and Souza, {Karla A S} and Gisela Tunes and Alencar, {Airlane P} and Varella, {Ana C} and Gooden, {Tiffany E} and Lip, {Gregoy Yh} and Santos, {Itamar S} and Lotufo, {Paulo A} and Bense{\~n}or, {Isabela M} and Goulart, {Alessandra C}",

note = "Grant support: This study was funded by the Sao Paulo Research Support Foundation of the State of S{\~a}o Paulo (FAPESP) (grant no 18/05512-3) and by the NIHR Global Health Research Group of AF (grant no 17/63/121). Copyright: {\textcopyright} 2023. Published by Elsevier Inc.",

year = "2024",

month = jan,

doi = "10.1016/j.jstrokecerebrovasdis.2023.107487",

language = "English",

volume = "33",

journal = "Journal of Stroke and Cerebrovascular Diseases",

issn = "1052-3057",

publisher = "WB Saunders",

number = "1",

}

de Goes, ACG, Souza, KAS, Tunes, G, Alencar, AP, Varella, AC, Gooden, TE, Lip, GY, Santos, IS, Lotufo, PA, Benseñor, IM & Goulart, AC 2024, 'Predictive value of functional disability scales among stroke survivors: A long-term mortality evaluation in a Brazilian stroke cohort', Journal of Stroke and Cerebrovascular Diseases, vol. 33, no. 1, 107487. https://doi.org/10.1016/j.jstrokecerebrovasdis.2023.107487

TY - JOUR

T1 - Predictive value of functional disability scales among stroke survivors

T2 - A long-term mortality evaluation in a Brazilian stroke cohort

AU - de Goes, Ana Cristina G

AU - Souza, Karla A S

AU - Tunes, Gisela

AU - Alencar, Airlane P

AU - Varella, Ana C

AU - Gooden, Tiffany E

AU - Lip, Gregoy Yh

AU - Santos, Itamar S

AU - Lotufo, Paulo A

AU - Benseñor, Isabela M

AU - Goulart, Alessandra C

N1 - Grant support: This study was funded by the Sao Paulo Research Support Foundation of the State of São Paulo (FAPESP) (grant no 18/05512-3) and by the NIHR Global Health Research Group of AF (grant no 17/63/121). Copyright: © 2023. Published by Elsevier Inc.

PY - 2024/1

Y1 - 2024/1

N2 - OBJECTIVE: To assess the influence of two functional scales- Modified Rankin Scale (m-RS) and Modified Katz Index (m-Katz Index) on long-term mortality in a stroke cohort.MATERIAL AND METHODS: Among 760 stroke survivors (median age: 66 (IQR:56-75), 56.4 % women) m-Katz Index and m-RS scales applied at 1 and 6 months after stroke, were investigated in relation to 12-years of all-cause mortality. Kaplan-Meier survival curves were computed, and time-varying covariate Cox regression models were fitted to calculate hazard ratios (HRs) with 95 % confidence intervals (CIs) in all sample and by sex. The prognostic ability of the fitted models was computed for each model by six different measures.RESULTS: After 12 years of follow-up (median survival time: 7.3 years), 311 participants died. Overall survival curves show lower survival rates among those with the highest levels of disability/dependence (all log-rank p-values <0.0001). These findings were confirmed in all regression models for both sexes, particularly in men who had higher levels of dependence on Activities of Daily Living (ADLs) by m-Katz Index and severe disability by m-RS and presented the highest HR of dying (HR: 3.34 (95 %CI: 2.27-4.92) and HR: 4.94 (95 % CI: 3.15-7.75), respectively).CONCLUSIONS: Both the m-Katz Index and the m-RS scale were good predictors of long-term mortality, which is of importance for guiding the functional rehabilitation of stroke patients. Besides, high levels of disability and dependence were implicated with high mortality risks, regardless of sex.

AB - OBJECTIVE: To assess the influence of two functional scales- Modified Rankin Scale (m-RS) and Modified Katz Index (m-Katz Index) on long-term mortality in a stroke cohort.MATERIAL AND METHODS: Among 760 stroke survivors (median age: 66 (IQR:56-75), 56.4 % women) m-Katz Index and m-RS scales applied at 1 and 6 months after stroke, were investigated in relation to 12-years of all-cause mortality. Kaplan-Meier survival curves were computed, and time-varying covariate Cox regression models were fitted to calculate hazard ratios (HRs) with 95 % confidence intervals (CIs) in all sample and by sex. The prognostic ability of the fitted models was computed for each model by six different measures.RESULTS: After 12 years of follow-up (median survival time: 7.3 years), 311 participants died. Overall survival curves show lower survival rates among those with the highest levels of disability/dependence (all log-rank p-values <0.0001). These findings were confirmed in all regression models for both sexes, particularly in men who had higher levels of dependence on Activities of Daily Living (ADLs) by m-Katz Index and severe disability by m-RS and presented the highest HR of dying (HR: 3.34 (95 %CI: 2.27-4.92) and HR: 4.94 (95 % CI: 3.15-7.75), respectively).CONCLUSIONS: Both the m-Katz Index and the m-RS scale were good predictors of long-term mortality, which is of importance for guiding the functional rehabilitation of stroke patients. Besides, high levels of disability and dependence were implicated with high mortality risks, regardless of sex.

KW - Cerebrovascular

KW - Rehabilitation medicine/Physical therapy

KW - Poststroke survival

KW - Epidemiology

U2 - 10.1016/j.jstrokecerebrovasdis.2023.107487

DO - 10.1016/j.jstrokecerebrovasdis.2023.107487

M3 - Article

C2 - 37980846

SN - 1052-3057

VL - 33

JO - Journal of Stroke and Cerebrovascular Diseases

JF - Journal of Stroke and Cerebrovascular Diseases

IS - 1

M1 - 107487

ER -

Predictive value of functional disability scales among stroke survivors: A long-term mortality evaluation in a Brazilian stroke cohort

Abstract

Bibliographical note

Keywords

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NIHR Global Research Group on Atrial Fibrillation

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