Motivation: So, how long does it take to recover? Even after more than a year of treating patients with acute stroke, I am not sure how to answer this question. I sometimes put it vaguely as "months." But, really, after how many months do most post-stroke patients complete their recovery?
Paper: Jorgensen HS, Nakayama H, Raaschou HO, Vive-Larsen J, Stoier M, Olsen TS. "Outcome and time course of recovery in stroke: Part II: Time course of recovery. The copenhagen stroke study." Arch Phys Med Rehabil (1995); 76: 406-412.
Methods: All patients with acute stroke in Copenhagen, Denmark between September, 1991 to 1993 were followed from time of acute admission to end of rehabilitation to six months post-stroke. Time course of recovery was plotted.
Results:
Cohort: The cohort of stroke survivors consisted of 947 patients (53% female) of mean age 73.3. The strokes were 93% ischemic and 7% hemorrhagic. The median time between symptom onset and admission was 16 hours. After rehabilitation, 19% were placed in nursing homes while 81% were discharged home.
Recovery: When assessed by the Scandinavian Stroke Scale (0-58 points, higher indicating milder deficits), best neurological recovery was reached in 80% by 4.5 weeks (95% CI: 4 to 5 weeks) and in 95% by 11 weeks (95% CI: 10.1 to 11.9 weeks) from stroke onset. Best ADL function (measured by Barthel Index) was reached in 80% by 6 weeks (95% CI: 5.3 to 6.7 weeks) and in 95% by 12.5 weeks (95% CI: 11.6 to 13.4).
Initial Severe Functional Deficits: Severity of functional deficits were judged by the Barthel Index (scale of 0 to 100 with very severe disability in 0-20 and no disability with score of 100). In those with very severe initial disability (index of 0-20), best ADL function was reached in 80% of patients within 11 weeks (95% CI: 10-12) and in 95% within 17 weeks (95% CI: 15-19).
Initially Mild Disability: In those with mild disability (Barthel Index 75-95), best ADL function was reached in 80% of patients within 2.5 weeks (95% CI: 2-3) in 95% of patients within 5 weeks (95% CI: 4-6).
Discussion: In this remarkable study with 100% follow-up of all stroke patients in Copenhagen over two years, the overall message is that 95% will regain their best ADL function in about three months. The rate of recovery is slower in those with more severe disability and more rapid in those with mild disability. However, even in those with very severe initial functional deficits, best ADL function was reached in 17 months. For general counseling purposes, an appropriate summary statement might be that mild strokes take about a month to regain best function while severe strokes take about four to five months to regain best function. While this study is well done, some cautionary aspects are that (1) acute stroke therapy has changed since the study, and (2) physical therapy has changed since the early 1990s. How these aspects change the natural history of stroke disorders is unclear. Also note that this study also talks about the rate of recovery and not the extent of recovery.
Paper: Jorgensen HS, Nakayama H, Raaschou HO, Vive-Larsen J, Stoier M, Olsen TS. "Outcome and time course of recovery in stroke: Part II: Time course of recovery. The copenhagen stroke study." Arch Phys Med Rehabil (1995); 76: 406-412.
Methods: All patients with acute stroke in Copenhagen, Denmark between September, 1991 to 1993 were followed from time of acute admission to end of rehabilitation to six months post-stroke. Time course of recovery was plotted.
Results:
Cohort: The cohort of stroke survivors consisted of 947 patients (53% female) of mean age 73.3. The strokes were 93% ischemic and 7% hemorrhagic. The median time between symptom onset and admission was 16 hours. After rehabilitation, 19% were placed in nursing homes while 81% were discharged home.
Recovery: When assessed by the Scandinavian Stroke Scale (0-58 points, higher indicating milder deficits), best neurological recovery was reached in 80% by 4.5 weeks (95% CI: 4 to 5 weeks) and in 95% by 11 weeks (95% CI: 10.1 to 11.9 weeks) from stroke onset. Best ADL function (measured by Barthel Index) was reached in 80% by 6 weeks (95% CI: 5.3 to 6.7 weeks) and in 95% by 12.5 weeks (95% CI: 11.6 to 13.4).
Initial Severe Functional Deficits: Severity of functional deficits were judged by the Barthel Index (scale of 0 to 100 with very severe disability in 0-20 and no disability with score of 100). In those with very severe initial disability (index of 0-20), best ADL function was reached in 80% of patients within 11 weeks (95% CI: 10-12) and in 95% within 17 weeks (95% CI: 15-19).
Initially Mild Disability: In those with mild disability (Barthel Index 75-95), best ADL function was reached in 80% of patients within 2.5 weeks (95% CI: 2-3) in 95% of patients within 5 weeks (95% CI: 4-6).
Discussion: In this remarkable study with 100% follow-up of all stroke patients in Copenhagen over two years, the overall message is that 95% will regain their best ADL function in about three months. The rate of recovery is slower in those with more severe disability and more rapid in those with mild disability. However, even in those with very severe initial functional deficits, best ADL function was reached in 17 months. For general counseling purposes, an appropriate summary statement might be that mild strokes take about a month to regain best function while severe strokes take about four to five months to regain best function. While this study is well done, some cautionary aspects are that (1) acute stroke therapy has changed since the study, and (2) physical therapy has changed since the early 1990s. How these aspects change the natural history of stroke disorders is unclear. Also note that this study also talks about the rate of recovery and not the extent of recovery.
My friend only take 1 month he able to walk.
ReplyDeleteA very informative blog! My grandmother had a severe stroke and she suffered from paralysis. It was a part of brain damage. It was very difficult for all of us in the beginning. Finally we decided to give her some rehabilitation treatments. We consulted a health service centre http://www.c-care.ca/blog/education/what-to-expect-during-stroke-rehabilitation/ . They did a great service. Their rehabilitation process was mainly concentrated on giving mental strength to the patient. Everything was managed neatly. I think my grandmother showed signs of improvement from the first month itself. By 6 months she was able to walk. I believe rehabilitation time depends on the treatment we give to our patients. Giving them mental strength matters a lot!
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