Clinical Predictors of Good Functional Outcome in Patients with Acute Stroke


  • Nualpis Intaratep Department of Rehabilitation Medicine, Maharat Nakhon Ratchasima Hospital, Nakhon Ratchasima, Thailand
  • Rachawan Suksathien Department of Rehabilitation Medicine, Maharat Nakhon Ratchasima Hospital, Nakhon Ratchasima, Thailand


Barthel index, functional outcomes, clinical predictors, stroke, rehabilitation


Objectives: To evaluate clinical predictors related to good functional outcomes in acute phase stroke patients.

Study design: Prognostic research with prospective cohort design.

Setting: Stroke Unit, Maharat Nakhon Ratchasima Hospital, Nakhon Ratchasima Province, Thailand.

Subjects: Acute stroke patients age over 18 years who were admitted for conservative treatment

Methods: Patients were interviewed face-to-face regarding general information and were physically examined for clinical predictors related to good functional outcome such as premorbid status, diagnosis, comorbid conditions, complications, neurological condition, and bed mobility ability. The Barthel index score was used to determine functional outcome at acute phase admission. The patients were later interviewed by phone to determine their Barthel index score at 2 weeks, 1 and 3 months. Statistical analysis of acute clinical predictors of good functional outcome was conducted using multivariable logistic regression.

Results: Two hundred patients were recruited of whom 6.5% were excluded from the study. The average age (SD) was 63.5 (15.2) years and 51.9% were male. At the 3-month follow-up, 82.9% of stroke-survival patients had a good functional outcome (Barthel index > 75). Clinical predictors of a good functional outcome included the ability to change the body position from supine to sitting, independent walking before admission, age less than 65 years and normal consciousness in the acute phase, with adjusted odd ratios (95% CI) of 21.63 (2.13-218.76), 15.80 (2.90-86.11), 4.95 (1.50-16.35) and 3.88 (1.65-9.16), respectively.

Conclusions: Among the stroke patients, the ability to change body position from supine to sitting, the ability to walk independently without gait aids before admission, age less than 65 years and normal consciousness in the acute phase were related to good functional outcome.


Download data is not yet available.


Feigin VL, Krishnamurthi RV, Parmar P, Norrving B, Mensah GA, Bennett DA, et al. GBD 2013 Writing Group; GBD 2013 Stroke Panel Experts Group. Update on the Global Burden of Ischemic and Hemorrhagic Stroke in 1990-2013: the GBD 2013 study. Neuroepidemiology. 2015;45:161-76.

Katan M, Luft A: Global Burden of Stroke. Neurol 2018;38:208-11.

Narayanaswamy V, Byung WY, Jeyaraj P, Jose CN. Stroke epidemiology in South, East, and South-East Asia: a review. J Stroke. 2017;19:286-94.

Suwanwela NC, Poungvarin N, the Asian Stroke Advisory Panel. Stroke burden and stroke care system in Asia. Neurol India. 2016; 64:46-51.

Suwanwela NC. Stroke epidemiology in Thailand. J Stroke. 2014; 16:1-7.

Shah MV. Rehabilitation of the older adult with stroke. Clin Geriatr Med. 2006;22:469-89.

Karges J, Smallfied S. A description of the outcomes, frequency, duration, and intensity of occupational, physical, and speech therapy in inpatient stroke rehabilitation. J Allied Health. 2009;38:E1-10.

Kovindha A, Kuptniratsaikul V, Dajpratham P, Massakulpan P, Piravej K, Archongka Y, et al. Thai Stroke Rehabilitation Registry (TSRR). J Thai Rehabili Med. 2007;17:31-6.

Suksathien R. Accessibility to medical rehabilitation service for acute stroke at Maharat Nakhon Ratchasima Hospital: Related factors and outcomes. J Thai Rehabil Med. 2014;24:37-43.

Dajpratham P, Kuptniratsaikul V, Putthakumnerd W, Limumpai P. Walking function at 1-year after stroke rehabilitation: a multicenter study. J Med Assoc Thai. 2014;97:107-12.

Wattanapan P, Kovindha A, Piravej K, Kuptniratsaikul V. Relationship between the ability to change from a supine to a sitting position at admission and mobility outcomes after stroke rehabilitation. J Med Assoc Thai. 2010;93 Suppl 3:S21-4.

Yamaguchi T, Yamamura O, Hamano T, Murakita K, Nakamoto Y. Premorbid physical activity is modestly associated with gait independence after a stroke: an exploratory study. Eur Rev Aging Phys Act. 2018;15:18.

Suksathien R, Sukpongthai T. Predictors of long-term functional outcomes in acute stroke patients. J Thai Rehabil Med. 2017;27: 96-100.

Peduzzi P, Concato J, Kemper E, Holford TR, Feinstein AR. A simulation study of the number of events per variable in logistic regression analysis. J Clin Epidemiol.1996;49:1373-9.

Gian Luca DP, Katia S, Elodie O, Monica R, Francesco M and Maurizio AL. Validity and Reliability of the Barthel Index Administered by Telephone. Stroke. 2011;42:2077-9.

Korner-Bitensky N, Wood-Dauphinee S. Barthel Index information elicited over the telephone. Is it reliable? Am J Phys Med Rehabil. 1995;74:9-18.

Jorgensen HS, Nakayama H, Raaschou HO, Vive-Larsen J, Stoier M, Olsen TS. Outcome and time course of recovery in stroke - part I: outcome, the copenhagen stroke study. Arch Phys Med Rehabil. 1995;76:399-405.

Franceschini M, Fugazzaro S, Agosti M, Sola C, Carlo AD, Cecconi L, et al, Italian Study Group on Implementation of Stroke Care (ISC Study). Acute phase predictors of 6-month functional outcome in Italian stroke patients eligible for in-hospital rehabilitation. Am J Phys Med Rehabil. 2018;97:467-75.

Kuptniratsaikul V, Kovindha A, Dajpratham P, Piravej K. Main outcomes of stroke rehabilitation: a multi-center study in Thailand. J Rehabil Med. 2009;41:54-8.

Harvey RL. Predictors of functional outcome following stroke. Phys Med Rehabil Clin N Am. 2015;26:583-98.

Chindaprasirt J, Sawanyawisuth K, Chattakul P, Limpawattana P, Tiamkao S, Aountri P, et al. Age predicts functional outcome in acute stroke patients with rt-PA treatment. ISRN Neurology [internet]. 2013. [cited 2022 Feb 24] 4 pages. Available from http://dx.doi. org/10.1155/2013/710681.

Veerbeek JM, Kwakkel G, Wegen EEV, Ket JC, Heymans MW. Early prediction of outcome of activities of daily living after stroke: a systematic review. Stroke. 2011;42:1482-8.

Woldag H, Gerhold LL, Groot MD, Wohlfart K, Wagner A, Hummelsheim H. Early prediction of functional outcome after stroke. Brain Inj. 2006;20:1047-52.

Uyttenboogaart M, Stewart RE, Vroomen PCAJ, Keyser JD, Luijckx GJ. Optimizing cutoff scores for the Barthel index and the modified Rankin scale for defining outcome in acute stroke trials. Stroke. 2005;36:1984-7.

Ministry of Public Health. Office of the Permanent Secretory. Health Administration Division. Guideline for intermediate care service plan: care guidelines. Samut Sakhon: Born to be publishing; 2562. [cited 2022 Feb 24]. p. 25-31. Available from:

Shigetaka N, Shinjiro T, Hirokazu U, Michiharu K, Toshifumi O, Koji K, et al. Relationship between Barthel Index scores during the acute phase of rehabilitation and subsequent ADL in stroke patients. J Med Invest. 2010;57:81-8.