Prognostic Factors for Changes in Activities of Daily Living After Acute Ischemic Stroke

Watcharasak  Phongprapai; Non  Sowanna; Thanin  Chattrapiban

doi:10.33192/smj.v78i8.280808

Authors

Watcharasak Phongprapai Sawanpracharak Hospital, Nakonsawan, Thailand
Non Sowanna Department of Family Medicine, Faculty of Medicine, Naresuan University, Phitsanulok, Thailand
Thanin Chattrapiban Clinical Epidemiology & Clinical Statistics Unit, Faculty of Medicine, Naresuan University, Phitsanulok, Thailand

DOI:

https://doi.org/10.33192/smj.v78i8.280808

Keywords:

Ischemic stroke, activities of daily living, prognostic factors, caregivers, functional recovery

Abstract

Objective: Disability in activities of daily living (ADL) is one of the most common sequelae of ischemic stroke. The factors that govern the course of functional recovery in this group of patients need to be identified to inform clinical management. The objective of this study was to explore the prognostic factors of ADL for the functional outcome of patients with acute ischemic stroke at 3-month follow-up.

Materials and Methods: A prospective cohort study in patients with acute ischemic stroke was performed. Prognostic factors were obtained from patient records. The Barthel index (BI) was used to evaluate functional status both before discharge and at a 3-month follow-up. Correlates of worsening or unchanged ADL were calculated using multivariable ordinal logistic regression.

Results: A total of 305 patients were enrolled (mean age, 65 years; male, 55.4%). At 3 months, ADL improved in 64.9% of patients, remained unchanged in 28.2%, and worsened in 6.9%. Several independent prognostic factors for worse or unchanged ADL at 3 months were identified and included: higher NIHSS (aOR = 2.70, 95% CI: 1.43–5.12), lower GCS (aOR = 3.03, 95% CI: 1.26–7.35), absence of thrombolytic therapy with rt-PA (aOR =17.52, 95% CI:2.84-346.30), and absence of a caregiver (aOR =4.95, 95% CI, 1.13–21.64).

Conclusions: Stroke severity (NIHSS, GCS) and acute intervention (rt-PA), as well as social support (caregivers), are important determinants of functional evolution in ischemic stroke patients. These results support the need for early risk stratification and optimized post-discharge support to enhance long-term rehabilitation outcomes.

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