Systematic review to identify proxy measures to assess post-stroke functional outcomes

Abstract

Objectives: To perform a systematic review of studies evaluating prognostic factors (proxy measures) to predict patients’ post-stroke functional outcome status recommended by clinical guidelines. Materials and methods: MEDLINE and Embase databases were searched from January 1, 2000, through January 8, 2021. Studies that evaluated stroke survivors and assessed a proxy measure's ability to predict functional outcome status as measured by the modified Rankin Scale (mRS), Barthel Index (BI), Glasgow Outcomes Scale, and/or Functional Independence Measure between 30 and 365 days post-stroke were included. Results: Nine studies met inclusion criteria (median N per study = 1699; range: 530–6809). Seven studies evaluated ischemic stroke ± transient ischemic attack (TIA), 1 evaluated subarachnoid hemorrhage, and 1 evaluated both ischemic and hemorrhagic stroke and TIA (each reported separately). All studies utilized mRS score to assess post-stroke functional outcome, while 3 utilized the BI. Home-time was the most frequently evaluated proxy (7/9, 77.8%) and had moderate-to-strong correlation/discriminative ability with 3- to 12-month post-stroke functional outcome measurement. Home-time was less able to discriminate between neighboring mRS score values >3 and was only weakly-to-moderately correlated with mRS in TIA patients. Discharge to a location other than home or a relative's home was assessed in 2 of 9 studies (22.2%) and was found to be a moderate-to-strong correlate/predictor of unfavorable mRS score. In a single study, index hospital length of stay weakly correlated with post-stroke function status. Conclusions: This systematic review provides evidence supporting the use of home-time and discharge destination as proxy measures for predicting post-stroke functional outcome.

Keywords

• Stroke
• Ischemic stroke
• Intracranial hemorrhages
• Systematic review