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Rate, degree, and predictors of recovery from disability following ischemic stroke

From the Stroke Unit (G.J.H.), Royal Perth Hospital, Perth, Australia; the School of Medicine and Pharmacology (G.J.H.), University of Western Australia, Crawley, Australia; and Sanofi-Aventis Recherche & Développement (J.S., Z.H., G.B., P.C., S.G.), Bagneux, France.

Address correspondence and reprint requests to Dr. Graeme J. Hankey, Stroke Unit, Department of Neurology, Royal Perth Hospital, 197 Wellington St., Perth, Australia 6001 gjhankey{at}cyllene.uwa.edu.au

Objective: To determine the rate, degree, and predictors of recovery from disabling ischemic stroke.

Methods: Patients with ischemic stroke enrolled in the Management of Atherothrombosis With Clopidogrel in High-Risk Patients (MATCH) study underwent long-term prospective assessment of their modified Rankin Scale (mRS) score. Disability (functionally dependent state) was defined as mRS 3, and recovery (functionally independent state) was defined as mRS < 3. The timing and the independent predictors of recovery were determined using a Cox proportional hazards multiple regression analysis.

Results: Of 7,599 patients enrolled with ischemic stroke or TIA, 1,662 (21.8%) were disabled (mRS 3) at baseline (median of 14 [0 to 96] days after stroke onset). Disability was moderate (mRS 3) in 931 (56%) patients, severe (mRS 4) in 691 (42%), and very severe (mRS 5) in 40 (2%). By 18 months, 877 (52.8%, 95% CI 50% to 55%) patients had recovered, 589 (63%, 60% to 66%) with moderate disability, 281 (41%, 37% to 44%) with severe disability, and 7 (17%, 7 to 33%) with very severe disability. Median time to recovery was 3 months for patients with moderate disability and 18 months for severe disability; 82.5% of severely disabled patients remained so at 18 months. Predictors of recovery were moderate disability (mRS 3) at baseline compared with severe (mRS 4: hazard ratio [HR] 2.13, 1.86 to 2.44) or very severe disabling stroke (HR 5.88, 2.86 to 12.5); younger women (aged <65 years, compared with 75 years; HR 1.85, 1.47 to 2.33); decreasing time (days) between the qualifying event and the baseline assessment (HR 1.01, 1.01 to 1.02); and the absence of previous ischemic stroke (HR 1.61, 1.35 to 1.92), concurrent peripheral artery disease (HR 1.61, 1.23 to 2.13), or diabetes (HR 1.30, 1.10 to 1.54).

Conclusions: Half of patients with disabling ischemic stroke recovered within 18 months, and recovery was greatest within 6 months. Significant predictors of recovery included the severity of the index stroke and no history of ischemic stroke, peripheral artery disease, or diabetes.

Supplemental data at www.neurology.org

The MATCH study was sponsored by Sanofi-Synthelabo Research and cofunded in the USA by Sanofi-Synthelabo and Bristol Myers Squibb.

Disclosure: G.J.H. was an investigator in the MATCH Trial and has received consulting fees and honoraria from Sanofi-Aventis and Bristol Myers Squibb. All other authors are employees of Sanofi-Aventis Recherche & Développement.

Data presented in part as an oral presentation at the 14th European Stroke Conference, May 25–28, 2005, Bologna, Italy.

Received July 18, 2006. Accepted in final form January 3, 2007.

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