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Research paper
Late functional improvement after lacunar stroke: a population-based study
  1. Aravind Ganesh,
  2. Sergei A Gutnikov,
  3. Peter Malcolm Rothwell,
  4. for the Oxford Vascular Study
    1. Centre for Prevention of Stroke and Dementia, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
    1. Correspondence to Prof Peter Malcolm Rothwell, John Radcliffe Hospital, Oxford OX39DU, UK; peter.rothwell{at}ndcn.ox.ac.uk

    Abstract

    Background Recovery in function after stroke involves neuroplasticity and adaptation to impairments. Few studies have examined differences in late functional improvement beyond 3 months among stroke subtypes, although interventions for late restorative therapies are often studied in lacunar stroke. Therefore, we compared rates of functional improvement beyond 3 months in patients with lacunar versus non-lacunar strokes.

    Methods In a prospective, population-based cohort of 3-month ischaemic stroke survivors (Oxford Vascular Study; 2002–2014), we examined changes in functional status (modified Rankin Scale (mRS), Rivermead Mobility Index (RMI), Barthel Index (BI)) in patients with lacunar versus non-lacunar strokes from 3 to 60 months poststroke, stratifying by age. We used logistic regression adjusted for age, sex and baseline disability to compare functional improvement (≥1 mRS grades, ≥1 RMI points and/or ≥2 BI points), particularly from 3 to 12 months.

    Results Among 1425 3-month survivors, 234 patients with lacunar stroke did not differ from others in 3-month outcome (adjusted OR (aOR) for 3-month mRS >2 adjusted for age/sex/National Institutes of Health Stroke Scale score/prestroke disability: 1.14, 95% CI 0.75 to 1.74, p=0.55), but were more likely to demonstrate further improvement between 3 months and 1 year (aOR (mRS) adjusted for age/sex/3-month mRS: 1.64, 1.17 to 2.31, p=0.004). The results were similar on restricting analyses to patients with 3-month mRS 2–4 and excluding recurrent events (aOR (mRS): 2.28, 1.34 to 3.86, p=0.002), or examining BI and RMI (aOR (RMI) adjusted for age/sex/3-month RMI: 1.78, 1.20 to 2.64, p=0.004).

    Conclusion Patients with lacunar strokes have significant potential for late functional improvement from 3 to 12 months, which should motivate patients and clinicians to maximise late improvements in routine practice. However, since late recovery is common, intervention studies enrolling patients with lacunar strokes should be randomised and controlled.

    • ischaemic stroke
    • functional outcome
    • lacunar strokes
    • recovery
    • rehabilitation
    • trail design

    This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: http://creativecommons.org/licenses/by/4.0/

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    Footnotes

    • Collaborators Rose M Wharton Oxford Vascular Study.

    • Contributors AG collected the data, performed the analysis and interpretation, and wrote the manuscript. SAG contributed to data collection. PMR conceived and designed the study, provided supervision and funding, interpreted the data, and revised the manuscript.

    • Funding OXVASC has been funded by the Wellcome Trust, Wolfson Foundation, and NIHR Oxford Biomedical Research Centre. PMR has received NIHR and Wellcome Trust Senior Investigator Awards. AG was funded by the Rhodes Trust.

    • Competing interests None declared.

    • Patient consent Not required.

    • Ethics approval The study was approved by the Oxfordshire Research Ethics Committee.

    • Provenance and peer review Not commissioned; externally peer reviewed.

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