Effect of socioeconomic status on functional and motor recovery after stroke: a European multicentre study
- Koen Putman1,
- Liesbet De Wit2,
- Miranda Schoonacker1,
- Ilse Baert2,
- Hilde Beyens3,
- Nadine Brinkmann4,
- Eddy Dejaeger3,
- Anne-Marie De Meyer5,
- Willy De Weerdt2,
- Hilde Feys2,
- Walter Jenni6,
- Christiane Kaske6,
- Mark Leys1,
- Nadina Lincoln7,
- Birgit Schuback6,
- Wilfried Schupp4,
- Bozena Smith7,
- Fred Louckx1
- 1Department of Health Sciences and Medical Sociology, Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium
- 2Department of Rehabilitation Sciences, Faculty of Kinesiology and Rehabilitation Sciences, Katholieke Universiteit Leuven, Leuven, Belgium
- 3University Hospital Pellenberg, Pellenberg, Belgium
- 4Fachklinik Herzogenaurach, Herzogenaurach, Germany
- 5LUDIT Centre, Katholieke Universiteit Leuven, Leuven, Belgium
- 6Rehaclinic Zurzach, Zurzach, Switzerland
- 7Institute of Work, Health and Organisations, University of Nottingham, Nottingham, UK
- Correspondence to: Dr Koen Putman Department of Health Sciences and Medical Sociology, Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Laarbeeklaan 103, 1090 Brussels, Belgium; kputman{at}vub.ac.be
- Received 30 March 2006
- Accepted 2 December 2006
- Revised 24 November 2006
- Published Online First 8 December 2006
Abstract
Background: Previous studies have shown an inverse gradient in socioeconomic status for disability after stroke. However, no distinction has been made between the period in the stroke rehabilitation unit (SRU) and the period after discharge. The purpose of this study was to examine the impact of education and equivalent income on motor and functional recovery for both periods.
Methods: 419 consecutive patients were recruited from six SRUs across Europe. The Barthel Index (BI) and Rivermead Motor Assessment (RMA) were measured on admission, at discharge and 6 months after stroke. Ordinal logistic regression models were used, adjusting for case mix. Cumulative odds ratios (OR) were calculated to measure differences in recovery between educational levels and income groups with adjustments for case mix.
Results: Patients with a low educational level were less likely to improve on the BI (OR 0.53; 95% CI 0.32 to 0.87) and the RMA arm during inpatient stay (OR 0.54; 95% CI 0.31 to 0.94). For this period, no differences in recovery were found between income groups. After discharge, patients with a low equivalent income were less likely to improve on all three sections of the RMA: gross function (OR 0.20; 95% CI 0.06 to 0.66), leg and trunk (OR 0.22; 95% CI 0.09 to 0.55) and arm (OR 0.30; 95% CI 0.10 to 0.87). No differences were found for education.
Conclusions: During inpatient rehabilitation, educational level was a determinant of recovery, while after discharge, equivalent income played an important role. This study suggests that it is important to develop a better understanding of how socioeconomic factors affect the recovery of stroke patients.
- BI, Barthel Index
- ISCED, International Standard Classification of Education
- OT, occupational therapy
- PT, physiotherapy
- RMA, Rivermead Motor Assessment
- RMA-GF, gross motor function of the Rivermead Motor Assessment
- RMA-LT, leg and trunk function of the Rivermead Motor Assessment
- RMA-AR, arm function of the Rivermead Motor Assessment
- SES, socioeconomic status
- SRU, stroke rehabilitation unit
Footnotes
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Published Online First 8 December 2006
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This article was developed within the framework of the research “Collaborative Evaluation of Rehabilitation in Stroke across Europe (CERISE)”, Quality of life-key action 6, 2001–2005, contract number QLK6-CT-2001-00170, funded by the European Commission and Sekretariat für Bildung und Forschung SBF (CH). It does not necessarily reflect its views and in no way anticipates the Commission’s future policy in this area.
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Competing interests: None.
