Long-Term Outcome Poststroke: Predictors of Activity Limitation and Participation Restriction

Objectives: To describe long-term activity limitation, participation restriction, and patients' overall perception of recovery among stroke patients 4 years poststroke, and to evaluate the association between the factors. In addition, the study investigated those factors present at the time of stroke onset, which could predict the level of activity limitation and participation restriction at 4 years poststroke. Design: Prospective, 4-year follow-up study. Setting: Subjects' homes, via telephone. Participants: All first ever stroke patients (N=139) admitted to the Sheba Medical Center in Israel between February and March 2004 were followed and reassessed for activity and participation restrictions. Interventions: Not applicable. Main Outcome Measures: Barthel index (BI) (activity limitation, BI<95) and Frenchay Activities Index (FAI) (participation restriction, FAI<30). Perception of recovery was assessed by 2 simple questions. Results: At 4 years poststroke, 9 patients (6.4%) were lost to follow-up, 71(54.1%) patients had survived; 42.3% with activity limitation, 28.2% were classified as restricted in participation, and 78.1% felt they had not completely recovered. Age at stroke onset and disability in the acute phase were the most significant predictors of activity limitation at 4 years poststroke. None of the demographic characteristics or baseline clinical features predicted participation restriction. A positive association (rho=0.6) was noted between activity limitation and participation restriction 4 years poststroke. Conclusions: This is the first study to describe long-term outcomes poststroke in Israel. Activity limitation and participation restriction remain highly prevalent up to 4 years after stroke. The potential influence of additional factors (psychosocial, cognitive, and environmental) as predictors of participation restriction should be topics for future investigation.