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Variations in care and outcome in the first year after stroke: a Western and Central European perspective
  1. C D A Wolfe1,
  2. K Tilling2,
  3. A Rudd3,
  4. M Giroud4,
  5. D Inzitari5
  1. 1Division of Public Health Sciences KCL, London, UK
  2. 2Department of Social Medicine Bristol, UK
  3. 3Department of Care of the Elderly, Guy’s and St Thomas’ Hospital, London, UK
  4. 4Service de Neurologie Hospital General, Dijon, France
  5. 5Department of Neurological and Psychiatric Sciences University of Florence, Italy
  1. Correspondence to:
 Professor C Wolfe
 Department of Public Health Sciences, Kings College London, Floor 5, Capital House, 42 Weston Street, London SE1 3QD; charles.wolfekcl.ac.uk

Abstract

Background: There are significant variations in the short term patterns of care and outcome after a first stroke in Europe.

Objective: To estimate the variation in stroke care and outcome up to 1 year after a stroke in selected European centres.

Methods: Hospital based stroke registers were established in 11 hospitals in seven western and central European countries to collect demographic, clinical, and resource use data at the time of first ever stroke during 1993–4. At 3 and 12 months, details of survival, activities of daily living score, and use of services were recorded. Univariate comparisons between centres were made using the χ2 test and stepwise regression was used to identify associations between centre, case mix, therapy provision, and outcomes.

Results: Of the 4048 patients registered, 23% were lost to follow up and 38% had died at 1 year. The proportions of survivors who felt they needed assistance at 12 months ranged from 35% in Italy to 77% in UK2. There were comparatively high amounts of therapy provided up to 1 year in UK3, France and Germany 1, mainly at home. At 1 year, social services were still providing support in UK1, UK5 and France, with some support in Germany 1 and family support was provided in France.

In multivariate analysis, after adjustment for case mix and receipt of rehabilitation, non-UK centres had improved activities of daily living (p<0.001). Older age was indicative of more need for assistance, but less likelihood of assistance from the family. Those in France were more likely to get assistance from their family than any other centre. Mainland European patients were more likely to get help from their family than those in the UK. Patients in all areas except UK2 and UK3 were more likely to be dead or dependent at 1 year than patients in UK1.

Conclusions: There were significant variations in the pathways of care for stroke across European centres in the mid 1990s, which were associated with variation in outcome, and remain unexplained. Family support is more prevalent in southern Europe and service support more prevalent in the UK.

  • ADL, activities of daily living
  • OT, occupational therapy
  • PT, physiotherapy
  • SLT, speech and language therapy
  • stroke
  • survival
  • variation in care
  • outcome

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Footnotes

  • Competing interests: none declared.