Follow-Up of the Collaborative Evaluation of Rehabilitation in Stroke Across Europe

Functional disability and motor impairments are important concerns post stroke, therefore improving functional and motor outcome is one of the main goals of stroke rehabilitation. Most recovery is seen in the first weeks after stroke, with the recovery slope reaching a plateau between 3 and 6 months. It remains unclear whether early improvements can be sustained long term after stroke. Knowledge of long-term outcomes after stroke rehabilitation is important for the optimization of patient management. Studies on long-term outcome after stroke are few. Most studies are community-based, some focus on mortality rates, or others use broad outcome measures, such as being functionally (in)dependent. Long-term functional and motor recovery patterns, measured between admission to rehabilitation and several years after stroke, have received less attention. Two studies with small sample sizes showed a small deterioration between discharge from rehabilitation and several years of follow-up. Reutter-Bernays and Rentsch reported a small, nonsignificant decrease in functional outcome over time, whereas Löfgren et al described a significant decrease in overall Fugl-Meyer Background and Purpose—Recovery of patients within the first 6 months after stroke is well documented, but there has been little research on long-term recovery. The aim of this study was to analyze functional and motor recovery between admission to rehabilitation centres and 5 years after stroke. Methods—This follow-up of the Collaborative Evaluation of Rehabilitation in Stroke Across Europe study, included patients from 4 European rehabilitation centres. Patients were assessed on admission, at 2 and 6 months, and 5 years after stroke, using the Barthel Index, Rivermead Motor Assessment Gross Function, Leg and Trunk function, and Arm function. Linear mixed models were used, corrected for baseline characteristics. To account for the drop-out during follow-up, the analysis is likelihood-based (assumption of missingness at random). Results—A total of 532 patients were included in this study, of which 238 were followed up at 5 years post stroke. Mean age at stroke onset was 69 (±10 SD) years, 53% were men, 84% had ischemic strokes, and 53% had left-sided motor impairment. Linear mixed model analysis revealed a significant deterioration for all 4 outcomes between 6 months and 5 years (P<0.0001). Scores at 2 months were not statistically significant different from scores at 5 years after stroke. Higher age (P<0.0001) and increasing stroke severity on admission (P<0.0001) negatively affected long-term functional and motor recovery. Conclusions—Five-year follow-up revealed deterioration in functional and motor outcome, with a return to the level measured at 2 months. Increasing age and increasing stroke severity negatively affected recovery up to 5 years after stroke. (Stroke. 2015;46:1613-1619. DOI: 10.1161/STROKEAHA.115.009421.)