Estimation of the Long-Term Care Needs of Stroke Patients by Integrating Functional Disability and Survival

Objectives: This study aimed to estimate the dynamic changes of different physical functional disabilities and life-time care needs for patients with stroke. Data Sources and Study Design: We examined a hospital-based cohort including 16,043 patients who had their first stroke during 1995-2010. The Barthel Index (BI) was used to measure disability levels in 1,162 consecutive patients, with a total of 1,294 measurements at the stroke clinics and the rehabilitation wards, and a cross-sectional design. Extraction Methods: The survival function was extrapolated to lifetime by a semi-parametric method and multiplied with proportions of different disabilities over time to obtain the long-term care needs for different stroke subtypes. Principal Findings: On average, stroke patients would suffer at least 0.86 years with mild disability, 1.24 years with moderate disability and 1.39 years with severe disability, as measured by the BI. Among these, patients with a cardio-embolic infarct or intracerebral hemorrhage (ICH) suffered more than 2 years of severe disability. Assistance in bathing was the most common need for care in stroke patients. Conclusions: Among different subtypes of stroke, cardio-embolic infarct and ICH lead to the longest durations of severe physical functional disability. The method presented in this work may also be applied to other chronic diseases and different functional disabilities.