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Long-Term Evolution of Functional Limitations in Stroke Survivors Compared With Stroke-Free Controls: Findings From 15 Years of Follow-Up Across 3 International Surveys of Aging
Stroke ( IF 8.3 ) Pub Date : 2021-09-02 , DOI: 10.1161/strokeaha.121.034534
Andres Gil-Salcedo 1 , Aline Dugravot 1 , Aurore Fayosse 1 , Louis Jacob 1, 2, 3 , Mikaela Bloomberg 4 , Séverine Sabia 1, 4 , Alexis Schnitzler 1, 5
Affiliation  

Background and Purpose:In the chronic phase 2 to 5 years poststroke, limitations in activities of daily living (ADL) and instrumental ADL (IADL) initially plateau before steady increasing. However, the impact of age and differences in initial levels of disability on the evolution of these limitations remains unclear. As such, this study aims to evaluate differences in long-term evolution of ADL/IADL limitations between stroke survivors and stroke-free population, and how limitations differ by initial level of disability for stroke survivors.Methods:Thirty-three thousand six hundred sixty participants (5610 first-ever stroke cases with no recurrence during follow-up and 28 050 stroke-free controls) aged ≥50 from the Health and Retirement Study, Survey of Health, Ageing and Retirement in Europe, and English Longitudinal Study of Ageing were assessed for number of ADL/IADL limitations during the poststroke chronic phase (for cases) and over follow-up years 1996 to 2018 (for controls). Three thousand seven hundred eighteen stroke cases were additionally categorized by disability level using the modified Rankin Scale score of 1 to 2 years poststroke. Evolution of ADL/IADL limitations was assessed in stroke cases and controls and by modified Rankin Scale score (0–1, 2–3, 4–5) using linear mixed models. Models were stratified by age group (50–74 and ≥75 years) and adjusted for baseline characteristics, health behaviors, BMI, and comorbidities.Results:Findings showed relative stability of ADL/IADL limitations during 3 to 6 years poststroke followed by an increase for both populations, which was faster for younger stroke cases, suggesting a differential age-effect (P<0.001). Disability level at 1 to 2 years poststroke influenced the evolution of limitations over time, especially for severe disability (modified Rankin Scale score, 4–5) associated with a reduction in limitations at 5 to 6 years poststroke.Conclusions:Our findings showed that during the poststroke chronic phase functional limitations first plateau and then increase and the evolution differs by disability severity. These results highlight the importance of adaptive long-term health and social care measures for stroke survivors.

中文翻译:

与无中风对照组相比,中风幸存者功能限制的长期演变:3 项国际老龄化调查 15 年随访的结果

背景和目的:在中风后 2 至 5 年的慢性期,日常生活活动 (ADL) 和工具性 ADL (IADL) 的限制最初处于稳定状态,然后稳定增加。然而,年龄和初始残疾程度的差异对这些限制的演变的影响仍不清楚。因此,本研究旨在评估中风幸存者和无中风人群之间 ADL/IADL 限制的长期演变差异,以及中风幸存者的初始残疾程度如何影响限制。方法:33660健康与退休研究、欧洲健康、老龄化与退休调查以及英国老龄化纵向研究中年龄≥50 岁的参与者(5610 名随访期间未复发的首次中风病例和 28050 名无中风对照)评估卒中后慢性期(病例)和 1996 年至 2018 年随访期间(对照)的 ADL/IADL 限制数量。3718 例中风病例还使用中风后 1 至 2 年的改良 Rankin 量表评分按残疾程度进行分类。使用线性混合模型通过改良Rankin量表评分(0-1、2-3、4-5)评估中风病例和对照的ADL/IADL限制的演变。模型按年龄组(50-74 岁和≥75 岁)进行分层,并根据基线特征、健康行为、BMI 和合并症进行调整。结果:研究结果显示,中风后 3 至 6 年内 ADL/IADL 限制相对稳定,随后有所增加对于这两个人群,年轻卒中病例的速度更快,表明年龄效应存在差异(P <0.001)。中风后 1 至 2 年的残疾水平影响了随着时间的推移限制的演变,特别是对于严重残疾(改良Rankin 量表评分,4-5),与中风后 5 至 6 年限制的减少相关。 结论:我们的研究结果表明,在中风后慢性期功能限制首先达到稳定状态,然后增加,并且其演变因残疾严重程度而异。这些结果凸显了适应性长期健康和社会护理措施对中风幸存者的重要性。
更新日期:2021-09-02
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