ABSTRACT
The purpose of this study was to assess the predictors of functional outcome after right hemisphere stroke at 6-month follow up in patients with or without thrombolytic treatment. Thrombolysis did not predict functional outcome in instrumental activities of daily living (IADL). Lower acute phase basic activities of daily living (ADL) measured by the Barthel Index was a statistically significant predictor of IADL when adjusted for age and education (p = .015) and had borderline significance (p = .076) as a predictor of functional outcome when adjusted for severity of stroke at admission. When stroke severity was taken into account also higher age became a statistically significant (p = .039) predictor of functional outcome. The acute phase neuropsychological symptoms predicted the functional outcome in unadjusted analyses but when adjusted for age, education, and severity of stroke no independent association was found.
Subject(s)
Activities of Daily Living , Brain Ischemia/psychology , Perceptual Disorders/psychology , Recovery of Function/physiology , Stroke/psychology , Thrombolytic Therapy , Adult , Age Factors , Aged , Brain Ischemia/complications , Brain Ischemia/drug therapy , Disability Evaluation , Female , Humans , Male , Middle Aged , Neuropsychological Tests , Perceptual Disorders/etiology , Predictive Value of Tests , Severity of Illness Index , Stroke/complications , Stroke/drug therapy , Treatment OutcomeABSTRACT
BACKGROUND: The aim of the study was to assess the association between thrombolysis and length of hospital stay after right hemisphere (RH) infarct, and to identify which cognitive functions were predictive of discharge. METHODS: The study group consisted of 75 acute RH patients. Thirty-three patients had thrombolysis. Neuropsychological examinations were performed within 11 days of stroke onset. The cognitive predictors were visual neglect, visual memory, visual search and reasoning and visuoconstructive abilities. The outcome variable was time from stroke to discharge to home. RESULTS: Thrombolysis emerged as a statistically significant predictor of discharge time in patients with moderate/severe stroke (NIHSS ≥5). In the total series of patients and in patients with mild stroke (NIHSS <5), thrombolysis was not significantly associated with discharge time. Milder visuoconstructive defects shortened the hospital stay of the whole patient group and of patients with moderate/severe stroke. In all patient groups, independence in activities of daily living (ADL) was a significant single predictor of a shorter hospital stay. The best combination of predictors for discharge was independence in ADL in the total series of patients and in patients with mild stroke, and thrombolysis and independence in ADL in patients with moderate/severe stroke. CONCLUSIONS: Thrombolytic treatment was a significant predictor of earlier discharge to home in patients with moderate/severe RH infarct, while cognitive functions had less predictive power.
