Butsing Nipaporn, Thongniran Nalinrat, Keandoungchun Jesada
Ramathibodi School of Nursing, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Ratchathewi, Thailand.
Nursing Services Division, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Ratchathewi, Thailand.
PLoS One. 2025 Aug 8;20(8):e0330086. doi: 10.1371/journal.pone.0330086. eCollection 2025.
Strokes are the major cause of disability. Functional recovery following an acute stroke is time-dependent and varies depending on several factors. This study aimed to investigate changes in functional outcomes after stroke from discharge to six months post-discharge and to identify factors associated with changes in functional outcomes during this six-month period.
The study included 155 consecutive patients with a first stroke and were hospitalized in an acute stroke unit at an advanced tertiary hospital in Bangkok between April 2020 and August 2021. The patients' functional outcomes were evaluated using the modified Rankin Scale (mRS) and the Barthel Index (BI) before hospital discharge and at one-, three-, and six-month post-discharge. Friedman tests were used to assess changes in mRS scores over six months. Linear mixed effect regression was applied to identify the change in BI scores during the six months post-discharge.
Of the participants, 62.6% were men, and the mean age was 64.0 (SD = 12.5). The median mRS scores ranged from 3.0 at discharge to 0.0 at six months post-discharge. Significant changes in mRS scores were identified within three months post-discharge, and differences by stroke subtype and severity (P < 0.05). The crude BI means ranged from 70.6 (SD = 28.5) at discharge to 93.1 (SD = 20.4) at six months post-discharge. Female participants and those with hemorrhagic strokes had lower adjusted BI scores compared to male participants and those with ischemic strokes, with differences of 4.1 and 4.5 points, respectively. Additionally, stroke severity was inversely related to adjusted BI scores. One increased National Institute of Health Stroke Scale (NIHSS) score decreased adjusted BI scores by 3.6.
The time after discharge, gender, stroke subtype, and stroke severity are significant factors affecting functional outcomes after a stroke. The most significant improvement in functional outcomes occurred within one month post-discharge.
中风是导致残疾的主要原因。急性中风后的功能恢复具有时间依赖性，且因多种因素而异。本研究旨在调查中风后从出院到出院后六个月功能结局的变化，并确定在此六个月期间与功能结局变化相关的因素。
该研究纳入了155例首次中风的连续患者，这些患者于2020年4月至2021年8月在曼谷一家高级三级医院的急性中风单元住院。在出院前以及出院后1个月、3个月和6个月，使用改良Rankin量表（mRS）和Barthel指数（BI）对患者的功能结局进行评估。采用Friedman检验评估六个月内mRS评分的变化。应用线性混合效应回归来确定出院后六个月内BI评分的变化。
参与者中，62.6%为男性，平均年龄为64.0岁（标准差=12.5）。mRS评分中位数从出院时的3.0降至出院后6个月时的0.0。出院后三个月内mRS评分有显著变化，且因中风亚型和严重程度而异（P<0.05）。BI粗均值从出院时的70.6（标准差=28.5）升至出院后6个月时的93.1（标准差=20.4）。与男性参与者和缺血性中风患者相比，女性参与者和出血性中风患者的调整后BI评分较低，分别相差4.1分和4.5分。此外，中风严重程度与调整后BI评分呈负相关。美国国立卫生研究院卒中量表（NIHSS）评分每增加1分，调整后BI评分降低3.6分。
出院时间、性别、中风亚型和中风严重程度是影响中风后功能结局的重要因素。功能结局的最显著改善发生在出院后一个月内。
