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

• Published in: Journal of stroke and cerebrovascular diseases Vol. 33; no. 1; p. 107487
• Main Authors: de Goes, Ana Cristina G, Souza, Karla A S, Tunes, Gisela, Alencar, Airlane P, Varella, Ana C, Gooden, Tiffany E, Thomas, Neil G, Lip, Gregoy Yh, Santos, Itamar S, Lotufo, Paulo A, Benseñor, Isabela M, Goulart, Alessandra C
• Format: Journal Article
• Language: English
• Published: United States 01.01.2024
• Subjects: Activities of Daily Living; Aged; Brazil; Disability Evaluation; Female; Humans; Male; Risk Factors; Stroke - diagnosis; Stroke - therapy; Survivors; Brazil; Cerebrovascular; Poststroke survival; Rehabilitation medicine/Physical therapy; Epidemiology
• ISSN: 1052-3057; 1532-8511
• DOI: 10.1016/j.jstrokecerebrovasdis.2023.107487

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. 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. 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). 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.