Skip to main content

Advertisement

Log in

Functional limitations and survival following stroke: Psychological and clinical predictors of 3-year outcome

  • Published:
International Journal of Behavioral Medicine Aims and scope Submit manuscript

Abstract

Previous studies predicting functional outcomes of stroke have mainly used clinical and demographic measures. This study examines the additional predictive value of psychological predictors. A cohort of patients were assessed on 6 occasions between admission to hospital and 3 years post-stroke, with 40 of the original sample of 101 being available at the final assessment. Demographic variables, clinical indexes, and psychological measures were used to predict survival to 3 years and 3-year functional recovery was assessed using measures derived from the Barthel Index which took account of initial levels of performance. For functional recovery, multiple regression analyses showed that fixed clinical and demographic indexes explained 16% to 40% of the variance in recovery. Perceptions of control 6 months after discharge added significantly to the predictive equations. Because these cognitions are modifiable, they offer opportunities for intervention to improve patient outcomes. Multiple regression showed that no psychological variables predicted survival.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  • Allen, C. M. C. (1984). Predicting the outcome of stroke: A prognostic score. Journal of Neurology, Neurosurgery and Psychiatry, 47, 475–480.

    Article  Google Scholar 

  • Anderson, G., Vestergaard, K., Ingemann-Nielsen, M., & Lauritzen, L. (1995). Risk factors for post stroke depression. Acta Psychiatrica Scandinavica, 92, 193–198.

    Article  Google Scholar 

  • Baron, R. M., & Kenny, D. A. (1986). The moderator-mediator variable distinction in social psychological research: Conceptual, strategic and statistical considerations. Journal of Personality and Social Psychology, 51, 1173–1182.

    Article  PubMed  Google Scholar 

  • Bendel, R. B., & Afifi, A. A. (1977). Comparison of stopping rules in forward regression. Journal of the American Statistical Association, 72, 46–53.

    Article  Google Scholar 

  • Dennis, M. S., Burn, J. P. S., Sandercock, P. A. G., Bamford, J. M., Wade, D. T., & Warlow, C. P. (1993). Long term survival after first ever stroke: The Oxfordshire Community Stroke Project. Stroke, 24, 796–800.

    PubMed  Google Scholar 

  • Ebrahim, S., Barer, D., & Nouri, F. (1987). An audit offollow-up services for stroke patients after discharge from hospital. International Disability Studies, 9, 103–105.

    PubMed  Google Scholar 

  • Fisher, K., & Johnston, M. (1996a). Emotional distress as a mediator of the relationship between pain and disability: An experimental study. British Journal of Health Psychology, 1, 207–218.

    Google Scholar 

  • Fisher, K., & Johnston, M. (1996b). Experimental manipulation of perceived control and its effect on disability. Psychology & Health, 11, 657–669.

    Article  Google Scholar 

  • Frasure-Smith, N., Lesperance, F., & Talajic M. (1993). Depression following myocardial infarction: Impact on 6 month survival. Journal of the American Medical Association, 270, 1819–1825.

    Article  PubMed  Google Scholar 

  • Frasure-Smith, N., Lesperance, F., & Talajic M. (1995). Depression and 18 month prognosis after myocardial infarction. Circulation, 91, 999–1005.

    PubMed  Google Scholar 

  • Gladman, J. R. F., Harwood, D. M. J., & Barer, D. H. (1992). Predicting the outcome of acute stroke: Prospective evaluation of five multivariate models and comparisons with simple methods. Journal of Neurology, Neurosurgery and Psychiatry, 55, 347–351.

    Article  Google Scholar 

  • Hier, D. B., & Edelstein, G. (1991). Clinical prediction rules from stroke outcome research. Stroke, 22, 1431–1436.

    PubMed  Google Scholar 

  • Hoffman, A., Pfiffer, D., Hornung, R., & Niederhauser, H. (1995). Psychological factors predict medical outcome following a first myocardial infarction. Coronary Artery Disease, 6, 147–152.

    Article  Google Scholar 

  • Hosmer, D. W., & Lemeshow, S. (1989). Applied logistic regression. New York: Wiley.

    Google Scholar 

  • House, A. (1987). Depression after stroke. British Medical Journal, 294, 76–79.

    Article  PubMed  Google Scholar 

  • Information and Statistics Division, Scotland. (1997). http://www.isdscotland.org

  • Johnston, M. (1996). Models of disability. The Psychologist, 9, 205–210.

    Google Scholar 

  • Johnston, M., Bonetti, D., & Pollard, B. (2002). Disability as behaviour: Models of measurement and explanation. In L. Backman & C. von Hofston (Eds.), Psychology at the turn of the millennium, Vol. 1: Cognitive, biological and health perspectives (pp. 319–334). Hove, England: Psychology Press.

    Google Scholar 

  • Johnston, M., Earll, L., Giles, M., McClenahan, R., Morrison, V., Wright, S., & Stevens, D. (1999). Mood as a predictor of disability and survival inpatients newly diagnosed with ALS/MND. British Journal of Health Psychology, 4, 127–136.

    Article  Google Scholar 

  • Johnston, M., Gilbert, P., Partridge, C., & Collins, J. (1992). Changing perceived control in patients with physical disabilities: an intervention study with patients receiving rehabilitation. British Journal of Clinical Psychology, 31, 89–94.

    PubMed  Google Scholar 

  • Johnston, M., Morrison, V., MacWalter, R., & Partridge, C. (1999). Perceived control, coping and recovery from disability following stroke. Psychology and Health, 14, 181–192.

    Article  Google Scholar 

  • Johnston, M., & Pollard, B. (2001). Consequences of disease: Testing the WHO ICIDH model. Social Science and Medicine, 53, 1261–1273

    Article  PubMed  Google Scholar 

  • Johnston, M., & Vogele, C. (1993). What benefits can psychological preparation for surgery achieve? Annals of Behavioral Medicine, 15, 245–256.

    Google Scholar 

  • Lewin, B., Robertson, I. H., Cay, E. L., & Campbell, M. (1992). A self-help post MI rehabilitation package—The Heart Manual: Effects on psychological adjustment, hospitalisation and GP consultation. Lancet, 339, 1036–1040.

    Article  PubMed  Google Scholar 

  • Lorig, K., Seleznick, M., Lubeck, D., Ung, E., Chastain, R. L., &, Holman, H. R. (1989). The beneficial outcomes of the arthritis self-management course are not adequately explained by behavior change. Arthritis and Rheumatism, 32, 91–95.

    Article  PubMed  Google Scholar 

  • MacDonald, E. R., Weidenfeld, S. A., Hillel, A., Carpenter, C. L., & Walter, R. A. (1994). Survival in amyotropic lateral sclerosis: The role of psychological factors. Archives of Neurology, 51, 17–23.

    Google Scholar 

  • MacWalter, R. (1990). Outcome in acute stroke: The Dundee stroke register project. Unpublished manuscript.

  • Mahoney, F. J., & Barthel, D. W. (1965). Functional evaluation: The Barthel Index. Maryland State Medical Journal, 14, 61–65.

    PubMed  Google Scholar 

  • Morrison, V., Johnston, M., & MacWalter, R. (2000). Predictors of distress following an acute stroke: Disability, control cognitions, and satisfaction with care. Psychology & Health, 15, 395–407.

    Article  Google Scholar 

  • Morrison, V., Johnston, M., MacWalter, R., & Pollard, B. (1998). Improving emotional outcomes following acute stroke: A preliminary evaluation of a work-book based intervention. Scottish Medical Journal, 43, 52–53.

    PubMed  Google Scholar 

  • Orbell, S., Johnston, M., Rowley, D., Espley, A., & Davey, P. (1998). Cognitive representations of illness and functional and affective adjustment following surgery for osteoarthritis. Social Science and Medicine, 47, 93–102.

    Article  PubMed  Google Scholar 

  • Orgogozo, J. M., Capildeo, R., Anagnostou, C. N., Juge, O., & Pere, J. J. (1983). Development of a neurological scale for clinical evaluation of middle cerebral artery (MCA) infarction (translation). La Presse Medicale, 48, 3039–3044.

    Google Scholar 

  • Parikh, R. M., Robinson, R. G., Lipsey, J. R., Starkstein, S. E., Fedoroff, J. P., & Price, T. R. (1990). The impact of post-stroke depression on recovery in ADL over a 2 year follow-up. Archives of Neurology, 47, 785–789.

    PubMed  Google Scholar 

  • Partridge, C., & Johnston, M. (1989). Perceived control and recovery from physical disability. British Journal of Clinical Psychology, 28, 53–60.

    PubMed  Google Scholar 

  • Pattie, A. H., & Gilleard, C. J. (1979). A manual of the Clifton Assessment Procedures for the Elderly (CAPE). Sevenoaks, Kent, England: Hodder & Stoughton.

    Google Scholar 

  • Robertson, I. H., Ridgeway, V., Greenfield, E., & Parr, A. (1997). A motor recovery after stroke depends on intact sustained attention: A 2-year follow-up study. Neuropsychology, 11, 1–6.

    Google Scholar 

  • Rummel, R. J. (1970). Applied factor analyses. Evanston, IL: Northwestern University Press.

    Google Scholar 

  • Schubert, D. S. P., Taylor, D., Lee, D. O. S., Mentari, A., & Tamaklo, W. (1992). Physical consequences of depression in stroke patients. General Hospital Psychiatry, 14, 69–76.

    Article  PubMed  Google Scholar 

  • Wade, D. T., & Langton-Hewer, R. (1987). Functional abilities after stroke: Measurement, natural history and prognosis. Journal of Neurology, Neurosurgery and Psychiatry, 50, 177–182.

    Article  Google Scholar 

  • Wade, D. T., Langton-Hewer, R., Skilbeck, C. E., & David, R. M. (1985). Stroke: A critical approach to diagnosis treatment and management. London: Chapman & Hall.

    Google Scholar 

  • Warlow, C. P., Dennis, M. S., van Gijn, J., Hankey, G.J., Sandercock, P. A. G., Bamford, J. M., & Wardlaw, J. (1996). Stroke: A practical guide to management. Oxford, England: Blackwell.

    Google Scholar 

  • Williams, R. B., Barefoot, J. C., Califf, R. M., Haney, T. L., Saunders, W. B., Pryor, D. B., et al. (1992). Prognostic importance of social and economic resources among medically treated patients with angiographically documented coronary disease. Journal of the American Medical Association, 267, 520–524.

    Article  PubMed  Google Scholar 

  • Wilson, L. A., & Brass, W. (1973). Brief assessment of the mental state in geriatric domiciliary practice: The usefulness of the Mental Status Questionnaire. Age and Ageing, 2, 92–101.

    Article  PubMed  Google Scholar 

  • World Health Organization. (1980). International classification of impairments, disabilities, and handicaps. Geneva, Switzerland: Author.

  • World Health Organization. (2001). The international classification of functioning, disability and health—ICF. Geneva, Switzerland: Author.

  • Zigmond, A. S., & Snaith, R. P. (1983). The Hospital Anxiety and Depression Scale. Acta Psychiatrica Scandinavica, 67, 361–370.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Marie Johnston.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Johnston, M., Pollard, B., Morrison, V. et al. Functional limitations and survival following stroke: Psychological and clinical predictors of 3-year outcome. Int. J. Behav. Med. 11, 187–196 (2004). https://doi.org/10.1207/s15327558ijbm1104_1

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1207/s15327558ijbm1104_1

Key words

Navigation