Department of Rehabilitation Medicine, Research Institute MOVE, Room -1Y.172.06, VU University Medical Center, PO Box 7057, De Boelelaan 1117, 1007 MB Amsterdam, the Netherlands.
Stroke. 2011 May;42(5):1482-8. doi: 10.1161/STROKEAHA.110.604090. Epub 2011 Apr 7.
Knowledge about robust and unbiased factors that predict outcome of activities of daily living (ADL) is paramount in stroke management. This review investigates the methodological quality of prognostic studies in the early poststroke phase for final ADL to identify variables that are predictive or not predictive for outcome of ADL after stroke.
PubMed, Ebsco/Cinahl and Embase were systematically searched for prognostic studies in which stroke patients were included ≤2 weeks after onset and final outcome of ADL was determined ≥3 months poststroke. Risk of bias scores were used to distinguish high- and low-quality studies and a qualitative synthesis was performed.
Forty-eight of 8425 identified citations were included. The median risk of bias score was 17 out of 27 (range, 6-22) points. Most studies failed to report medical treatment applied, management of missing data, rationale for candidate determinants and outcome cut-offs, results of univariable analysis, and validation and performance of the model, making the predictive value of most determinants indistinct. Six high-quality studies showed strong evidence for baseline neurological status, upper limb paresis, and age as predictors for outcome of ADL. Gender and risk factors such as atrial fibrillation were unrelated to this outcome.
Because of insufficient methodological quality of most prognostic studies, the predictive value of many clinical determinants for outcome of ADL remains unclear. Future cohort studies should focus on early prediction using simple models with good clinical performance to enhance application in stroke management and research.
了解能够可靠且无偏地预测日常生活活动（ADL）结局的因素，对于脑卒中管理至关重要。本综述旨在调查脑卒中后早期预测 ADL 结局的预后研究的方法学质量，以确定哪些变量可预测、哪些不可预测脑卒中后 ADL 的结局。
系统检索 PubMed、Ebsco/Cinahl 和 Embase 数据库，纳入发病后≤2 周的脑卒中患者，且 ADL 结局在发病后≥3 个月时确定的预后研究。采用偏倚风险评分来区分高质量和低质量研究，并进行定性综合分析。
共纳入 8425 篇文献中的 48 篇。偏倚风险评分中位数为 17 分（范围为 6-22 分）。大多数研究未报告所应用的治疗方法、缺失数据的处理、候选预测因素的合理性和结局截断值、单变量分析结果，以及模型的验证和效能，使得大多数预测因素的预测价值不明确。6 项高质量研究强烈提示基线神经功能状态、上肢瘫痪和年龄是 ADL 结局的预测因素。性别和心房颤动等危险因素与 ADL 结局无关。
由于大多数预后研究的方法学质量较低，许多临床预测因素对 ADL 结局的预测价值仍不明确。未来的队列研究应注重使用具有良好临床性能的简单模型进行早期预测，以提高其在脑卒中管理和研究中的应用。
