London, United Kingdom 2013 1 Rehabilitation and reorganisation after stroke A 8:30 - 8:40 A European multi-center prediction of personal and extended activities of daily living six months after stroke G. Verheyden1, K. Putman2, N. Bockx3, E. Dejaeger4, W. Jenni5, N. Lincoln6, W. Schupp7, H. Feys8, W. De Weerdt9, L. De Wit10 Neuromotor Research Group, Department of Rehabilitation Sciences, KU Leuven, Leu-ven, BELGIUM1,Department of Medical Sociology and Health Sciences, Vrije Universiteit Brussel and School of Health, University of Central Lancashire, United Kingdom, Brussels, BELGIUM2, Neuromotor Research Group, Department of Rehabilitation Sciences, KU Leu-ven, Leuven, BELGIUM3, University Hospital Pellenberg, Pellenberg, BELGIUM4, RehaClinic Zurzach, Zurzach, SWITZERLAND5, Institute of Work, Health and Organisations, University of Nottingham, Nottingham, UNITED KINGDOM6, Fachklinik Herzogenaurach, Herzogenau-rach, GERMANY7, Neuromotor Research Group, Department of Rehabilitation Sciences, KU Leuven, Leuven, BELGIUM8, Neuromotor Research Group, Department of Rehabilitation Sci-ences, KU Leuven, Leuven, BELGIUM9, Department of Medical Sociology and Health Sciences, Vrije Universiteit Brussel, Brussels, BELGIUM10 Background Current prediction models are mostly based on a limited number of participants recruited from a single setting, limiting generalizability of findings. The CERISE study (Col-laborative Evaluation In Stroke Rehabilitation across Europe) investigated in-patient stroke rehabilitation in 532 people with stroke in four European rehabilitation centers. The aim of this study was to determine predictors of personal and extended activities of daily living at six months after stroke. Methods People were recruited from centers in Belgium, Germany, United Kingdom and Switzerland. Data were collected on admission and at two and six months post stroke. In total, 26 variables were recorded comprising patient- and stroke-specific information, comorbidities, motor and functional capabilities and socio-economic factors. We conducted a multivariate logistic regression, predicting personal activities of daily living (ADL) (Barthel Index (BI) score; good outcome=BI≥95/100) and extended ADL (Nottingham Extended ADL (NEADL) score; good outcome=NEADL≥12/22) at six months. Sensitivity and specificity of the prediction models was calculated. Results (see Table 1) The model predicting good BI out-come (N=468) included being male, having a higher BI at two months and better arm function at two months post stroke. The prediction equation showed a sensitivity of 81% and a specific-ity of 89%. The model predicting good NEADL outcome (N=465) included being male, hav-ing a higher BI score at two months and having a greater improvement in arm function from admission to two months post stroke. Sensitivity and specificity of the model was 80% and 88%, respectively. Conclusion Gender, Barthel Index score and arm function score determined outcome at six months after stroke with both good sensitivity and specificity. To the best of our knowledge, this is the largest, European, multi-center study that has been conducted in this area, with applicable prediction equations for the clinical setting. Cerebrovasc Dis 2013; 35 (suppl 3)1-854 93 9 Acute stroke: emergency management, stroke units and complications A 9:50 - 10:00 Uncontrolled hypertension in patients otherwise eligible for IVT: prevalence and outcome related to an active or conservative strategies. T.P. Zonneveld1, W.F. Westendorp2, P.J. Nederkoorn3, N.D. Kruyt4 on behalf of the TRUTH investigators Academic Medical center, Amsterdam, THE NETHERLANDS1,Academic Medical Center, Amsterdam, THE NETHERLANDS2, Academic Medical Center, Amsterdam, THE NETHER-LANDS3, Slotervaartziekenhuis, Amsterdam, THE NETHERLANDS4 BACKGROUND: Clinical guidelines are ambiguous concerning uncontrolled hypertension (UH) in patients otherwise eligible for intravenous thrombolysis (IVT). In Dutch centres about 60% of vascular neurologists actively lowers UH and 40% uses a conservative “measure and wait” strategy. The objective of this study was to determine the prevalence of UH in patients otherwise eligible for IVT and to explore relations of the different strategies with outcome. METHODS: Data were retrieved from two large clinical trials, and treatment strategies regard-ing UH (active or conservative) were documented. From the ongoing Preventive Antibiotics in Stroke Study (PASS) which enrols patients within 24 hours from symptom onset, data were used to assess the prevalence of UH in patients otherwise eligible for IVT. From both the PASS and Antiplatelet therapy in combination with rt-PA Thrombolysis in Ischemic Stroke (ARTIS) study data were used to explore relations with clinical outcome, symptomatic intracerebral hae-morrhage and door-to-needle times. RESULTS: In PASS, we identified 41 patients (15%) with UH otherwise eligible for IVT. In the active group (n=16) UH was successfully lowered in 14 cases (88%). In the conservative group (n=25) UH persisted in 13 patients (52%). In both stud-ies together 30 patients were treated actively and 30 received conservative treatment. Treatment strategy was not associated with clinical outcome, symptomatic intracerebral haemorrhage (one in each group) or length of the door-to-needle-time. CONCLUSION: UH in patients otherwise eligible for IVT is common (15%). UH was successfully lowered in the majority of patients with an active strategy whereas with a conservative strategy UH did not drop spontaneously in more than half of the cases, withholding IVT. In this relatively small series treatment strategy was not associated with outcome. This will be addressed in our recently started prospective ThRombolysis and UnconTrolled Hypertension (TRUTH-) study. 8:30-10:00 Oral Session Room 9,10 Rehabilitation and reorganisation after stroke A Chairs: M. Hommel, France and N. Ward, UK
Karger_ESC London_2013
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