Division of Geriatric Medicine, Groote Schuur Hospital and University of Cape Town.
S Afr Med J. 2011 May;101(5):345-8. doi: 10.7196/samj.4588.
To determine survival, disability and functional outcomes of stroke patients following their discharge from an acute stroke unit in an urban community with limited rehabilitative resources.
Stroke patients were recruited from a district hospital in Cape Town and followed-up for 6 months. Clinical characteristics, demographic and socioeconomic data, and disability and function as measured by modified Rankin Score (mRS), modified Barthel Index (mBI) at recruitment and 3 follow-up visits, were recorded.
The study included 196 patients. Median age was 60 (IQR 51-69) years, 135 (68.9%) were female, 57.7% black, 42.3% coloured, and 45 (23%) died within 6 months. At discharge, median mBI score was 7 (IQR 3-12) and median mRS 4 (IQR 3-5). In the multivariate regression models, only function (mBI OR 0.88, 95% confidence interval (CI) 0.79-0.96, p < 0.0001) and disability (mRS OR 2.34, 95%CI 1.20-4.54, p < 0.0001) were independently associated with risk of death. Shack housing was independently associated with moderate or severe disability (odds ratio 3.42, 95% CI 1.22-9.59, p = 0.02). Despite limited rehabilitation resources, 67% of survivors had mild to moderate disability at 6 months.
Apart from initial stroke severity, risk factors for poor survival were a severe disability category and the presence of impaired swallowing at discharge. Shack housing was independently associated with poor functional outcomes. These findings should be helpful in allocating home-based care and inpatient rehabilitation resources to high-risk groups to improve outcomes.
在康复资源有限的城市社区中，从急性卒中单元出院后，确定卒中患者的生存、残疾和功能结局。
在开普敦的一家区医院招募卒中患者，并进行 6 个月的随访。记录临床特征、人口统计学和社会经济学数据以及残疾和功能，采用改良 Rankin 评分（mRS）、改良巴氏指数（mBI）在招募时和 3 次随访时进行评估。
研究纳入 196 例患者。中位年龄为 60（IQR 51-69）岁，135 例（68.9%）为女性，57.7%为黑人，42.3%为混血儿，45 例（23%）在 6 个月内死亡。出院时，mBI 评分中位数为 7（IQR 3-12），mRS 中位数为 4（IQR 3-5）。在多变量回归模型中，只有功能（mBI OR 0.88，95%置信区间（CI）0.79-0.96，p<0.0001）和残疾（mRS OR 2.34，95%CI 1.20-4.54，p<0.0001）与死亡风险独立相关。棚屋住房与中重度残疾独立相关（比值比 3.42，95%CI 1.22-9.59，p=0.02）。尽管康复资源有限，但67%的幸存者在 6 个月时仍有轻度至中度残疾。
除了初始卒中严重程度外，不良生存的危险因素还包括严重残疾类别和出院时吞咽功能受损。棚屋住房与不良功能结局独立相关。这些发现有助于为高风险人群分配家庭护理和住院康复资源，以改善结局。
