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Trends in Activities of Daily Living among Stroke Survivors: Analysis from the South London Stroke Register

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Original languageEnglish
Pages (from-to)6-21
JournalInternational Journal of Rehabilitation Research
Volume2
Issue number2
DOIs
StatePublished - 2013

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Abstract

Background National and international acute stroke care guidelines came into effect during the last decade to improve outcomes after stroke but their impact on activities of daily living (ADL) improvement over time is not known. The aim of the study was to examine post-stroke ADL trends over time in a multiethnic population in England, and to examine these trends in different socio-economic groups. Methods Data from the South London Stroke Register were analysed from 1995 to 2011. At 3 months and 1 year post-stroke, basic and instrumental ADL were measured using Barthel Index (poor outcome- BI score<15) and Frenchay Activities Index (poor outcome- FAI score<=15), respectively. Simple and multiple logistic regression analyses were performed. Results At 3 months post-stroke, the prevalence of poor basic ADL reduced significantly from 33.4% in 1995-1998 to 25.1% in 2008-2011 (trend p<0.001) and poor instrumental ADL declined significantly from 59.8% to 53.1% (trend p=0.005). The corresponding figures at 1 year were: from 27.8% to 24.3% (trend p=0.001) and from 51.6% to 42.8% (trend p=0.004). At 3 months, significant reduction in poor ADL was observed over time in the first (least deprived) and second Index of Multiple Deprivation (IMD) tertiles (trend p=0.006 and 0.001, respectively in poor basic ADL; 0.019 and 0.047, respectively in poor instrumental ADL). At 1 year, poor basic ADL declined significantly in the first and third IMD tertiles (trend p=0.002 and 0.043, respectively), whereas poor instrumental ADL reduced significantly only in the first IMD tertile (trend p=0.05). Conclusion ADL has improved over time among stroke survivors. This may reflect the effectiveness of acute stroke care. Disparities in ADL improvement still exist in different socio-economic groups, and health inequality needs to be tackled.

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