Long-term restrictions in participation in stroke survivors under and over 70 years of age

Figures & data

Table 1. Patients characteristics (n = 326).

	Total group (n = 326)	Age ≥70 yrs (n = 140)	Age <70 yrs (n = 186)	p values
Demographic factors
Sex (% male)	65.0	61.4	67.7
Age in years	66.5 ± 12.4	77.9 ± 5.6	57.9 ± 8.5
Marital status (% living together)	70.6	60.7	78.0
High education level (%)^a	26.2	26.4	25.9
Stroke-related factors
Ischemic stroke (%)	92.9	91.4	94.1	0.344
Left hemisphere (%)	38.7	37.1	39.8	0.628
First stroke (%)	86.8	82.1	90.3	0.031^d
Severity of stroke 4 days after stroke	2.7 ± 3.3	2.7 ± 3.1	2.7 ± 3.4	0.532
No stroke symptoms (% NIHSS 0)	24.2	24.3	24.2	0.728
Minor stroke symptoms (% NIHSS 1–4)	56.7	56.4	57.0
Moderate stroke symptoms (% NIHSS 5–12)	16.6	17.9	15.6
Severe stroke symptoms (% NIHSS ≥13)	2.5	1.4	3.2
ADL 4 days after stroke	16.8 ± 4.9	15.8 ± 5	17.5 ± 4.6	<0.001^d
% ADL-dependent (BI ≤17)	33.7	45.7	24.7	<0.001^d
Cognitive functioning 2 months after stroke	23.7 ± 3.8	22.3 ± 3.8	24.7 ± 3.5	<0.001^d
% cognitively impaired (MoCA ≤25)	67.0	78.0	58.6	<0.001^d
Length of stay in hospital (in days)	8.3 ± 5.8	8.9 ± 6.5	7.9 ± 5.2	0.139
Discharge home after hospital stay (%)	70.2	62.9	75.8	0.011^d
Emotional functioning
Depression symptoms 2 months after stroke	4.7 ± 4	4.8 ± 4	4.6 ± 3.9	0.637
% depression symptoms (HADS-D ≥8)	22.4	22.7	22.2	0.917
Anxiety symptoms 2 months after stroke	4.7 ± 3.9	4.4 ± 3.9	5.0 ± 3.8	0.097
% anxiety symptoms (HADS-A ≥8)	20.8	15.2	25.1	0.034^d
Comorbidity (CIRS)	3.9 ± 2.7	4.7 ± 2.8	3.3 ± 2.5	<0.001^d
USER-P restriction subscale
Total score^b
Restriction subscale	79.2 ± 20.7	73.9 ± 22.2	83.1 ± 18.6	<0.001^d
Restriction items^c
Work/education	55.4 (n = 121)	60.0 (n = 15)	54.7 (n = 106)	0.700
Housekeeping	53.7	60.8	48.6	0.036^d
Mobility	41.4	52.0	33.9	<0.001^d
Physical exercise	55.9	62.6	51.2	0.059
Going out	45.2	54.2	39.3	0.023^d
Outdoor activities	51.6	59.8	45.5	0.019^d
Leisure indoors	29.8	30.5	29.2	0.818
Partner relationship	35.1 (n = 225)	42.3 (n = 78)	31.3 (n = 147)	0.099
Visits to family/friends	39.5	49.6	31.8	<0.001^d
Visits from family/friends	22.0	22.7	21.6	0.825
Telephone/PC contact	20.3	22.7	18.5	0.375

Values are percentages or mean ± SD.

ADL: activities of daily living; BI: Barthel Index; HADS-D: Hospital Anxiety and Depression Scale-depression subscale; HADS-A: Hospital Anxiety and Depression Scale-Anxiety subscale; MoCA, Montreal Cognitive Assessment; NIHSS: National Institutes of Health Stroke Scale; CIRS: Cumulative Illness Rating Scale.

^a Completed University of Professional Education and higher.

^b Higher scores indicate better participation outcome.

^c Restriction items values are percentages of patients who are restricted or dissatisfied.

^d p values are significant.

Table 2. Biviarate and multivariate analyses: predictors for unfavorable (worst quartile) and favorable (best quartile) USER-participation scores one year after stroke in patients ≥70 years old.

		Worst quartile versus rest (reference): predictors for unfavorable participation outcomes									Best quartile versus rest (reference): predictors for favorable participation outcomes
Stroke survivors ≥70 years old (n = 140)		Bivariate analysis					Multivariate analysis (n = 132)				Bivariate analysis					Multivariate analysis (n = 132)
Factors (measure)	Reference	N	β	SE	p values	OR (95% CI)	β	SE	p values	OR (95% CI)	N	β	SE	p values	OR (95% CI)	β	SE	p values	OR (95% CI)
Demographic factors
Sex	Female	140	−0.30	0.40	0.446	0.74 (0.34–1.61)			^a		140	0.23	0.42	0.779	1.26 (0.55–2.88)			^a
Age at stroke onset	–	140	0.06	0.03	0.062	1.07 (1.00–1.14)	0.08	0.04	0.044^a	1.08 (1.00–1.17)	140	−0.10	0.04	0.019	0.91 (0.83–0.98)	−0.10	0.05	0.026^a	0.90 (0.83–0.99)
Marital status	Married	140	0.42	0.40	0.288	1.53 (0.70–3.33)			^a		140	−0.27	0.42	0.518	0.76 (0.33–1.74)			^a
Education	Low	140	−0.66	0.50	0.187	0.52 (0.20–1.38)			^a		140	0.50	0.44	0.248	1.65 (0.70–3.88)			^a
Stroke-related factors
Severity of stroke (NIHSS)	–	140	0.13	0.06	0.037	1.14 (1.01–1.28)	0.16	0.07	0.016^a	1.17 (1.03–1.33)	140	−0.23	0.11	0.026	0.79 (0.64–0.97)	−0.20	0.12	0.094	0.82 (0.64–1.04)
Stroke history	First stroke	140	0.24	0.50	0.633	1.27 (0.48–3.36)			^a		140	0.08	0.52	0.881	1.08 (0.39–2.99)			^a
Hemisphere	Left	140	0.11	0.41	0.798	1.11 (0.50–2.49)			^a		140	−0.02	0.42	0.962	0.98 (0.43–2.22)			^a
Stroke type	Ischemic	139	−0.52	0.80	0.515	0.59 (0.12–2.85)			^a		139	0.16	0.70	0.814	1.18 (0.30–4.65)			^a
ADL 4 days after stroke	BI >17	140	0.54	0.40	0.174	1.72 (0.79–3.74)			^a		140	−1.17	0.45	0.009	0.31 (0.13–0.75)	−0.55	0.52	0.297	0.58 (0.21–1.61)
Cognitive functioning	MoCA >25	132	0.43	0.54	0.427	1.54 (0.53–4.46)			^a		132	−0.05	0.49	0.925	0.96 (0.36–2.51)			^a
Emotional functioning
Depression symptoms	HADS-D <8	132	0.72	0.46	0.119	2.05 (0.83–5.06)			^a		132	−1.18	0.65	0.070	0.31 (0.09–1.10)	−0.59	0.71	0.408	0.56 (0.14–2.23)
Anxiety symptoms	HADS-A <8	132	1.00	0.51	0.051	2.73 (0.99–7.48)	1.17	0.57	0.039^a	3.23 (1.06–9.82)	132	−1.89	1.05	0.071	0.15 (0.02–1.18)	−1.80	1.11	0.103	0.16 (0.02–1.44)
Comorbidity (CIRS)	–	133	0.14	0.07	0.061	1.15 (0.99–1.33)	0.14	0.08	0.075	1.16 (0.99–1.35)	133	−0.18	0.08	0.029	0.84 (0.71–0.98)	−0.15	0.09	0.097	0.86 (0.72–1.03)
Constant							−8.96	3.29								8.17	3.55

ADL: activities of daily living; BI: Barthel Index; CI: confidence interval; CIRS: Cumulative Illness Rating Scale; HADS-A: Hospital Anxiety and Depression Scale-Anxiety subscale; HADS-D: Hospital Anxiety and Depression Scale-Depression subscale; MoCA: Montreal Cognitive Assessment; MoCA: Montreal Cognitive Assessment; NIHSS: National Institutes of Health Stroke Scale; OR: odds ratio; SE: standard error; β: standardized regression coefficient.

^a p values are significant (p < 0.05).

Table 3. Biviarate and multivariate analyzes: predictors for unfavorable (worst quartile) and favorable (best quartile) USER-participation scores one year after stroke in patients <70 years old.

		Worst quartile versus rest (reference): predictors for unfavorable participation outcomes									Best quartile versus rest (reference): predictors for favorable participation outcomes
Stroke survivors <70 years old (n = 186)		Bivariate analysis					Multivariate analysis (n = 169)				Bivariate analysis					Multivariate analysis (n = 170)
Factors (measure)	Reference	N	β	SE	p values	OR (95% CI)	β	SE	p values	OR (95% CI)	N	β	SE	p values	OR (95% CI)	β	SE	p values	OR (95% CI)
Demographic factors
Sex	Female	186	0.65	0.35	0.063	0.52 (0.26–1.04)	−0.93	0.43	0.030^a	0.39 (0.17–0.91)	186	0.90	0.36	0.013	2.46 (1.21–5.00)	0.71	0.40	0.078	2.04 (0.92–4.49)
Age at stroke onset	–	186	0.00	0.02	0.943	1.00 (0.96–1.04)			^a		186	0.02	0.02	0.274	1.02 (0.98–1.06)			^a
Marital status	Married	186	0.2	0.42	0.641	1.22 (0.53–2.79)			^a		186	−0.16	0.38	0.680	0.86 (0.41–1.80)			^a
Education	Low	185	−0.47	0.42	0.257	0.62 (0.28–1.41)			^a		185	−0.04	0.36	0.903	0.96 (0.48–1.92)			^a
Stroke-related factors
Severity of stroke (NIHSS)	–	186	0.12	0.05	0.012	1.13 (1.03–1.23)	0.20	0.08	0.013^a	1.22 (1.04–1.42)	186	−0.06	0.05	0.222	0.94 (0.85–1.04)			^a
Stroke history	First stroke	186	0.47	0.53	0.377	1.60 (0.56–4.54)			^a		186	0.21	0.51	0.674	1.24 (0.46–3.37)			^a
Hemisphere	Left	186	−0.08	0.35	0.808	0.92 (0.47–1.81)			^a		186	0.05	0.32	0.884	1.05 (0.56–1.94)			^a
Stroke type	Ischemic	186	−0.41	0.8	0.606	0.66 (0.14–3.18)			^a		186	0.49	0.63	0.430	1.64 (0.48–5.59)			^a
ADL 4 days after stroke	BI >17	186	0.94	0.37	0.010	2.57 (1.25–5.30)	0.14	0.51	0.791	1.15 (0.42–3.13)	186	−0.82	0.40	0.040	0.44 (0.20–0.96)	−0.55	0.45	0.222	0.58 (0.24–1.39)
Cognitive functioning	MoCA >25	174	0.64	0.38	0.090	1.89 (0.91–3.95)	0.88	0.44	0.047^a	2.41 (1.01–5.76)	174	−0.49	0.32	0.126	0.61 (0.33–1.15)			^a
Emotional functioning
Depression symptoms	HADS-D <8	171	1.41	0.4	<0.001	4.08 (1.86–8.97)	1.43	0.44	0.001^a	4.17 (1.77–9.83)	171	−1.57	0.51	0.002	0.21 (0.08–0.57)	−1.04	0.58	0.070	0.35 (0.11–1.09)
Anxiety symptoms	HADS-A <8	171	0.53	0.4	0.183	1.70 (0.78–3.71)			^a		171	−1.54	0.47	0.001	0.22 (0.08–0.55)	−0.89	0.54	0.103	0.41 (0.14–1.19)
Comorbidity (CIRS)	–	178	0.08	0.07	0.215	1.09 (0.95–1.24)			^a		178	−0.13	0.07	0.064	0.88 (0.77–1.01)	−0.10	0.08	0.184	0.90 (0.78–1.05)
Constant							−2.11	0.48								−0.30	0.46

ADL: activities of daily living; BI: Barthel Index; CI: confidence interval; CIRS: Cumulative Illness Rating Scale; HADS-A: Hospital Anxiety and Depression Scale-Anxiety subscale; HADS-D: Hospital Anxiety and Depression Scale-Depression subscale; MoCA: Montreal Cognitive Assessment; NIHSS: National Institutes of Health Stroke Scale; OR: odds ratio; SE: standard error; β: standardized regression coefficient.

^a p values are significant (p <0.05).