Published Online
on August 24, 2006

A more recent version of this article appeared on September 1, 2006

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Submitted on May 14, 2006
Accepted on June 19, 2006

Impact of Time on Improvement of Outcome After Stroke

Gert Kwakkel PhD^*; Boudewijn Kollen PhD; and Jos Twisk PhD

From the Department of Rehabilitation (G.K.), VU University Medical Centre and Rehabilitation Centre "De Hoogstraat," Rudolf Magnus Institute of Neuroscience, UMC Utrecht, The Netherlands; the Research Bureau (B.K.), Isala klinieken, Zwolle, The Netherlands; and the Department of KEB (J.T.), VU Medical Centre, Amsterdam, The Netherlands.

^* To whom correspondence should be addressed. E-mail: g.kwakkel{at}vumc.nl.

Background and Purpose--Longitudinal conducted studies show that neurologic and functional recovery show faster recovery in the first weeks poststroke. The aim of the present study was to study the effects of progress of time on observed improvements in motor strength, synergisms, and activities during the first 16 weeks poststroke.

Methods--Based on data from a previous study, 101 patients with first-ever ischemic middle cerebral artery strokes were prospectively investigated during the first 16 weeks after stroke. Progress of time was categorized into 8 biweekly time intervals and was used as the independent covariate in a first-order longitudinal regression model. The biweekly time change (progress of time) was related to improvement in upper and lower limb motor recovery assessed with Fugl-Meyer score and Motricity Index, reduction in visuospatial inattention based on the letter cancellation task, and improvement in walking ability, dexterity, and activities of daily living measured with the Functional Ambulation Categories, Action Research Arm test, and Barthel Index.

Results--Time explained a significant change of 8.4 (42%) measurement units on the Barthel Index for the first 10 weeks poststroke, 1.1 (22%) measurement units on Functional Ambulation Categories, and 19% on the Action Research Arm test for the first 6 and 8 weeks poststroke. Approximately 25% (for Fugl-Meyer-arm) to 26% (for Motricity Index-arm) of the significant change in measurements units was explained by time alone for the upper limb compared with 33% for Fugl-Meyer-leg and 39% for Motricity Index-leg of the lower limb. Time accounted for a reduction of 16% in the letter cancellation task. Observed associations did not change after controlling for covariates such as age, gender, hemisphere of stroke, type of stroke, or intervention.

Conclusion--Progress of time is an independent covariate that reflects spontaneous recovery of body functions and activities explaining 16% to 42% of the observed improvements in the first 6 to 10 weeks after stroke onset.

Key words: activities of daily living • prognosis • recovery of function • regression analysis • spontaneous remission

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