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The Role of Prognostic Scores in Targeting Stroke Rehabilitation in Elderly Patients
Author(s) -
Kalra L.,
Crome P.
Publication year - 1993
Publication title -
journal of the american geriatrics society
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.992
H-Index - 232
eISSN - 1532-5415
pISSN - 0002-8614
DOI - 10.1111/j.1532-5415.1993.tb06947.x
Subject(s) - medicine , activities of daily living , stroke (engine) , rehabilitation , physical therapy , cohort , prospective cohort study , barthel index , dementia , physical medicine and rehabilitation , disease , mechanical engineering , engineering
Objective : To determine the validity of clinically derived prognostic scores in targeting stroke rehabilitation in elderly patients. Design, Setting and Participants : One‐year prospective cohort study in 96 hospitalized stroke patients over 75 years of age from a well defined geographical area. Measurements : Edinburgh prognostic score (incorporating measures of motor deficit, proprioception, and power), Orpington prognostic score (Edinburgh score modified to include a measure of cognition), and Barthel ADL scores were measured at 1, 2, and 4 weeks after stroke. These scores were correlated with outcome and patients' Barthel ADL score at discharge or at 16 weeks if still in hospital. Results : Edinburgh prognostic score measured at 2 weeks correlated significantly with Barthel ADL score at discharge or at 16 weeks ( r 2 = 0.57, P < 0.001), and Orpington prognostic scores showed greater correlation ( r 2 = 0.89 vs 0.57), especially in patients with dementia ( r 2 = 0.81 vs 0.39). Barthel ADL scores at 2 weeks showed a weak correlation with Barthel ADL scores at discharge or 16 weeks ( r 2 = 0.58). Patients with Orpington Score <3.2 were discharged within 3 weeks of stroke, whereas those scoring <5.2 required long‐term care. Most patients (90%) with Orpington Score of 3–5 were eventually discharged home although this was not always apparent on initial clinical assessment at the time of admission. Conclusions : The Orpington score when assessed at 2‐weeks post‐stroke is a useful prognostic indicator with special suitability for the elderly and may help to select patients most likely to benefit from stroke unit rehabilitation.