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Public Health Weekly Report 2022; 15(7): 435-449

Published online February 17, 2022

© The Korea Disease Control and Prevention Agency

Comparisons of the characteristics, initial treatment, rehabilitation therapy and long-term functional outcomes of first-ever stroke patients over a 10-year period: The KOSCO Study

Yun-Hee Kim1, Won Hyuk Chang1, Seyoung Shin1, Doo-na Cho1, Deog Young Kim2, Yong Wook Kim2, Dae Hyun Kim2, Ji-hyun Park2, Jongmin Lee3, Hyun-Haeng Lee3, Min Kyun Sohn4, Sung-Ju Jee4, Sam-Gyu Lee5, Min-Keun Song5, Yong-il Shin6, Sung-Hwa Ko6, Ji-Hong Min6, Yang-Soo Lee7, Yu-Sun Min7, Ae-Ryoung Kim7, Min Cheol Joo8, Ji-hee Kim8, Gyung-Jae Oh9, Young-Hoon Lee9, So Young Lee10, Jun Hee Han11, Jeonghoon Ahn12, Soo Mi Choi13, Jeesoo Seo13, Seon Kui Lee13

1Department of Physical and Rehabilitation Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
2Department and Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul, Korea
3Department of Rehabilitation Medicine, Konkuk University School of Medicine, Seoul, Korea
4Department of Rehabilitation Medicine, Chungnam National University College of Medicine, Daejeon, Korea
5Department of Physical and Rehabilitation Medicine, Chonnam National University Medical School, Gwangju, Korea
6Department of Rehabilitation Medicine, Pusan National University School of Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea
7Department of Rehabilitation Medicine, Kyungpook National University School of Medicine, Kyungpook National University Hospital, Daegu, Korea
8Department of Rehabilitation Medicine, Wonkwang University School of Medicine, Iksan, Korea
9Department of Preventive Medicine, Wonkwang University, School of Medicine, Iksan, Korea
10Department of Rehabilitation Medicine, Jeju National University Hospital, Jeju National University School of Medicine, Jeju, Korea
11Department of Statistics, Hallym University, Chuncheon, Korea
12Department of Health Convergence, Ewha Womans University, Seoul, Korea
13Division of Chronic Disease Prevention, Bureau of Chronic Disease Prevention and Control, Korea Disease Control and Prevention Agency

Abstract

Sections

The incidence of stroke has increased, and most stroke survivors are left with some degree of residual disability, which places a significant burden on patients, caregivers, and the society. Development of structured stroke care requires long-term assessment of functional outcomes to identify the factors that influence residual disability and quality of life in stroke survivors.
The Korean Stroke Cohort for Functioning and Rehabilitation (KOSCO) is a multi-center, prospective, longitudinal study conducted to investigate the survival and recurrence rates, functional status, mood, and quality of life of patients who have suffered ischemic or hemorrhagic strokes based on face-to-face assessments and interviews. In this study, we also conducted rehabilitation intervention studies to investigate the effects of early intensive rehabilitation therapies on long-term functional outcomes, and analyzed the cost-effectiveness of early intensive rehabilitation therapy in first-ever stroke patients.
Of the 10,636 patients who had suffered their first-ever stroke and who were admitted to 9 hospitals in Korea between August 2012 and May 2015, 7,858 patients agreed to participate in the follow-up study and were enrolled in the 1st Korean Stroke Cohort. The 2nd Korean Stroke Cohort conducted beteween January and December 2020 and included 2,413 patients who agreed to participate in the follow-up study out of the 4,065 patients examined. The clinical and early treatment characteristics of stroke patients differed between the 1st and 2nd Korean Stroke Cohorts, reflecting socio-environmental changes such as aging and medical insurance coverage of stroke care.
Patients in the 2nd Korean Stroke Cohort patients had a significantly higher mean age, higher prevalence of metabolic syndrome and higher previous functional level than those in the 1st Korean Stroke Cohort. In addition the rate of admission to stroke unit increased among patients in the 2nd Korean Stroke Cohort, and the number of patients who received interventional and rehabilitation treatment during the initial hospital reatment increased. Overall, functional outcomes at six months after stroke onset were better in the 2nd Korean Stroke Cohort. In addition, a multiple regression analysis showed that intensive rehabilitation treatment and pneumonia during the initial hospitalization were significant modifiable factors at three months after stroke onset.
These results provide useful information for establishing a comprehensive and structured stroke care system and national policy development for better management of stroke patients.

Key words Stroke, Cohort study, Mortality, Rehabilitation, Functional outcome, Quality of life

Sections
Table 1. Comparison of patient characteristics between the 1st and 2nd Korean Stroke Cohorts
Characteristics1st Korean Stroke Cohort2nd Korean Stroke Cohort
Ischemic stroke (%)77.2%76.7%
Hemorrhagic stroke (%)22.8%23.3%
Mean age (year)65.1±13.567.0±13.3*
Previous functional level, normal (%)69.9%83.5%*
Comorbidity (CCAS ≥8)5.13±1.872.72±1.98*

*p<0.05

CCAS, Combined condition and age-related score

Table 2. Comparison of initial treatment and rehabilitation therapy between the 1st and 2nd Korean Stroke Cohorts
Factors1st Korean Stroke Cohort2nd Korean Stroke Cohort
Patients admitted to Stroke Unit (%)48.9%62.7%*
Hospital day (day, mean±SD)18.0±23.215.1±27.6*
Consultation for Rehabilitation (%)75.1%85.7%*
Consultation for Rehabilitation (day)2.7±5.62.1±4.7*
Transfer to Rehabilitation department (%)16.5%19.7%*
Transfer to Rehabilitation department (day)16.8±14.813.4±13.7*

*p<0.05

Table 3. Multiple regression analysis of ischemic stroke patients three months after stroke onset
Factors1st Korean Stroke Cohort2nd Korean Stroke Cohort
β(p-value)β(p-value)
Age-0.268<0.001*-0.162<0.001*
Alcohol1.3080.014*-
CCAS--0.0500.035*
Premorbid mRS0.761<0.001*0.6360.003*
7 day stroke severity (NIHSS)--1.3140.004*
7 day cognitive function (K-MMSE)-1.706<0.001*-0.5520.007*
7 day motor function (FMA)0.173<0.001*0.258<0.001*
7 day ambulatory function (FAC)0.273<0.001*2.371<0.001*
7 day swallowing fucntion (AHSA-NOMS)1.120<0.001*-
7 day language function (K-FAST-SF)-0.3490.006*
Pneumonia-7.2260.002*-17.710<0.001*
Urinary tract infection-8.860<0.001*-
Initial hospitalization days-0.127<0.001*-
Intensive rehabilitation treatment5.357<0.001*4.1880.002*

*p<0.05

CCAS, Combined condition and age-related score; mRS. modified Rankin Scale; NIHSS, National Institutes of Health Stroke Scale; FMA, Fugl-Meyer Assessment; FAC, Functional Ambulatory Categories; ASHA-NOMS, Speech-Language-Hearing Association National Outcome Measurement System; K-FAST-SF, Korean version of Frenchay Aphasia Screening Test Short Form

Table 4. Multiple regression analysis of hemorrhagic stroke patients three months after stroke onset
Factors1st Korean Stroke Cohort2nd Korean Stroke Cohort
β(p-value)β(p-value)
Age-0.465<0.001*-0.466<0.001*
Premorbid mRS1.2050.018*-
7 day stroke severity (NIHSS)-0.822<0.001*-
7 day motor function (FMA)0.205<0.001*0.390<0.001*
7 day ambulatory function (FAC)-2.279<0.001*
7 day swallowing fucntion (AHSA-NOMS)1.518<0.001*-
Pneumonia-11.3160.002*-73.613<0.001*
Respiratory failure-18.8020.003--
Initial hospitalization days-0.151<0.001*-

*p<0.05

mRS. modified Rankin Scale; NIHSS, National Institutes of Health Stroke Scale; FMA, Fugl-Meyer Assessment; FAC, Functional Ambulatory Categories; ASHA-NOMS, Speech-Language-Hearing Association National Outcome Measurement System

Figure 1. Distribution of 11 institutions that participated in the Korean Stroke Cohort Study

Figure 2. Comparison of stroke risk factors
*p<0.05

Figure 3. Comparison of initial stroke treatment
*p<0.05

Figure 4. The incidence of disability at six months after stroke onset
K-MBI, Korean version of Modified Barthel Index

Figure 5. Comparison of the active daily living function (K-MBI) of patients who received intensive rehabilitation during initial hospitalization
*p<0.05
REH, rehabilitation medicine departmentt; K-MBI, Korean version of Modified Barthel Index

References

Sections
  1. Barker-Collo S, et al. Auckland stroke outcomes study: part 2: cognition and functional outcomes 5 years poststroke. Neurology 2010;75(18):1608-1616.
    Pubmed CrossRef
  2. 국가통계포털 https://kosis.kr/index/index.do, 2020
  3. Chang W.H., et al. Korean Stroke Cohort for functioning and rehabilitation (KOSCO): study rationale and protocol of a multicentre prospective cohort study. BMC Neurol 2015;15(1):1-7.
    Pubmed KoreaMed CrossRef
  4. Chang W.H., et al. Role of Intensive Inpatient Rehabilitation for Prevention of Disability after Stroke: The Korean Stroke Cohort for Functioning and Rehabilitation (KOSCO) Study. Brain & Neurorehabilitation 2016;9(2):1-10.
    CrossRef
  5. 안정훈 등. 보건의료 의사결정에서 비용-효과성에 관한 아시아 공동연구. 한국보건의료연구원 연구보고서 2012;1(1):1-76.
  6. 질병관리청한국뇌졸중재활코호트연구단. 우리나라 초발 뇌졸중 생존율과 후유장애 및 재활에 관한 10년 연구보고서 (2021).
  7. Veerbeek JM, Kwakkel G, van Wegen EE, Ket JC, Heymans MW. Early prediction of outcome of activities of daily living after stroke: a systematic review. Stroke; a journal of cerebral circulation 2011;42(5):1482-8.
    Pubmed CrossRef
  8. Parker VM, Wade DT, Langton Hewer R. Loss of arm function after stroke: measurement, frequency, and recovery. Int Rehabil Med 1986;8(2):69-73.
    Pubmed CrossRef
  9. Meijer R, van Limbeek J, Peusens G, et al. The Stroke Unit Discharge Guideline, a prognostic framework for the discharge outcome from the hospital stroke unit. A prospective cohort study. Clin Rehabil 2005;19(7):770-8.
    Pubmed CrossRef
  10. Kim BR, Han EY, Joo SJ, Kim SY, Yoon HM. Cardiovascular fitness as a predictor of functional recovery in subacute stroke patients. Disabil Rehabil 2014;36(3):227-31.
    Pubmed CrossRef

Original Articles

Public Health Weekly Report 2022; 15(7): 435-449

Published online February 17, 2022

Copyright © The Korea Disease Control and Prevention Agency.

Comparisons of the characteristics, initial treatment, rehabilitation therapy and long-term functional outcomes of first-ever stroke patients over a 10-year period: The KOSCO Study

Yun-Hee Kim1, Won Hyuk Chang1, Seyoung Shin1, Doo-na Cho1, Deog Young Kim2, Yong Wook Kim2, Dae Hyun Kim2, Ji-hyun Park2, Jongmin Lee3, Hyun-Haeng Lee3, Min Kyun Sohn4, Sung-Ju Jee4, Sam-Gyu Lee5, Min-Keun Song5, Yong-il Shin6, Sung-Hwa Ko6, Ji-Hong Min6, Yang-Soo Lee7, Yu-Sun Min7, Ae-Ryoung Kim7, Min Cheol Joo8, Ji-hee Kim8, Gyung-Jae Oh9, Young-Hoon Lee9, So Young Lee10, Jun Hee Han11, Jeonghoon Ahn12, Soo Mi Choi13, Jeesoo Seo13, Seon Kui Lee13

1Department of Physical and Rehabilitation Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
2Department and Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul, Korea
3Department of Rehabilitation Medicine, Konkuk University School of Medicine, Seoul, Korea
4Department of Rehabilitation Medicine, Chungnam National University College of Medicine, Daejeon, Korea
5Department of Physical and Rehabilitation Medicine, Chonnam National University Medical School, Gwangju, Korea
6Department of Rehabilitation Medicine, Pusan National University School of Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea
7Department of Rehabilitation Medicine, Kyungpook National University School of Medicine, Kyungpook National University Hospital, Daegu, Korea
8Department of Rehabilitation Medicine, Wonkwang University School of Medicine, Iksan, Korea
9Department of Preventive Medicine, Wonkwang University, School of Medicine, Iksan, Korea
10Department of Rehabilitation Medicine, Jeju National University Hospital, Jeju National University School of Medicine, Jeju, Korea
11Department of Statistics, Hallym University, Chuncheon, Korea
12Department of Health Convergence, Ewha Womans University, Seoul, Korea
13Division of Chronic Disease Prevention, Bureau of Chronic Disease Prevention and Control, Korea Disease Control and Prevention Agency

Abstract

The incidence of stroke has increased, and most stroke survivors are left with some degree of residual disability, which places a significant burden on patients, caregivers, and the society. Development of structured stroke care requires long-term assessment of functional outcomes to identify the factors that influence residual disability and quality of life in stroke survivors.
The Korean Stroke Cohort for Functioning and Rehabilitation (KOSCO) is a multi-center, prospective, longitudinal study conducted to investigate the survival and recurrence rates, functional status, mood, and quality of life of patients who have suffered ischemic or hemorrhagic strokes based on face-to-face assessments and interviews. In this study, we also conducted rehabilitation intervention studies to investigate the effects of early intensive rehabilitation therapies on long-term functional outcomes, and analyzed the cost-effectiveness of early intensive rehabilitation therapy in first-ever stroke patients.
Of the 10,636 patients who had suffered their first-ever stroke and who were admitted to 9 hospitals in Korea between August 2012 and May 2015, 7,858 patients agreed to participate in the follow-up study and were enrolled in the 1st Korean Stroke Cohort. The 2nd Korean Stroke Cohort conducted beteween January and December 2020 and included 2,413 patients who agreed to participate in the follow-up study out of the 4,065 patients examined. The clinical and early treatment characteristics of stroke patients differed between the 1st and 2nd Korean Stroke Cohorts, reflecting socio-environmental changes such as aging and medical insurance coverage of stroke care.
Patients in the 2nd Korean Stroke Cohort patients had a significantly higher mean age, higher prevalence of metabolic syndrome and higher previous functional level than those in the 1st Korean Stroke Cohort. In addition the rate of admission to stroke unit increased among patients in the 2nd Korean Stroke Cohort, and the number of patients who received interventional and rehabilitation treatment during the initial hospital reatment increased. Overall, functional outcomes at six months after stroke onset were better in the 2nd Korean Stroke Cohort. In addition, a multiple regression analysis showed that intensive rehabilitation treatment and pneumonia during the initial hospitalization were significant modifiable factors at three months after stroke onset.
These results provide useful information for establishing a comprehensive and structured stroke care system and national policy development for better management of stroke patients.

Keywords: Stroke, Cohort study, Mortality, Rehabilitation, Functional outcome, Quality of life

Body

Comparison of patient characteristics between the 1st and 2nd Korean Stroke Cohorts
Characteristics1st Korean Stroke Cohort2nd Korean Stroke Cohort
Ischemic stroke (%)77.2%76.7%
Hemorrhagic stroke (%)22.8%23.3%
Mean age (year)65.1±13.567.0±13.3*
Previous functional level, normal (%)69.9%83.5%*
Comorbidity (CCAS ≥8)5.13±1.872.72±1.98*

*p<0.05.

CCAS, Combined condition and age-related score.

Comparison of initial treatment and rehabilitation therapy between the 1st and 2nd Korean Stroke Cohorts
Factors1st Korean Stroke Cohort2nd Korean Stroke Cohort
Patients admitted to Stroke Unit (%)48.9%62.7%*
Hospital day (day, mean±SD)18.0±23.215.1±27.6*
Consultation for Rehabilitation (%)75.1%85.7%*
Consultation for Rehabilitation (day)2.7±5.62.1±4.7*
Transfer to Rehabilitation department (%)16.5%19.7%*
Transfer to Rehabilitation department (day)16.8±14.813.4±13.7*

*p<0.05.

Multiple regression analysis of ischemic stroke patients three months after stroke onset
Factors1st Korean Stroke Cohort2nd Korean Stroke Cohort
β(p-value)β(p-value)
Age-0.268<0.001*-0.162<0.001*
Alcohol1.3080.014*-
CCAS--0.0500.035*
Premorbid mRS0.761<0.001*0.6360.003*
7 day stroke severity (NIHSS)--1.3140.004*
7 day cognitive function (K-MMSE)-1.706<0.001*-0.5520.007*
7 day motor function (FMA)0.173<0.001*0.258<0.001*
7 day ambulatory function (FAC)0.273<0.001*2.371<0.001*
7 day swallowing fucntion (AHSA-NOMS)1.120<0.001*-
7 day language function (K-FAST-SF)-0.3490.006*
Pneumonia-7.2260.002*-17.710<0.001*
Urinary tract infection-8.860<0.001*-
Initial hospitalization days-0.127<0.001*-
Intensive rehabilitation treatment5.357<0.001*4.1880.002*

*p<0.05.

CCAS, Combined condition and age-related score; mRS. modified Rankin Scale; NIHSS, National Institutes of Health Stroke Scale; FMA, Fugl-Meyer Assessment; FAC, Functional Ambulatory Categories; ASHA-NOMS, Speech-Language-Hearing Association National Outcome Measurement System; K-FAST-SF, Korean version of Frenchay Aphasia Screening Test Short Form.

Multiple regression analysis of hemorrhagic stroke patients three months after stroke onset
Factors1st Korean Stroke Cohort2nd Korean Stroke Cohort
β(p-value)β(p-value)
Age-0.465<0.001*-0.466<0.001*
Premorbid mRS1.2050.018*-
7 day stroke severity (NIHSS)-0.822<0.001*-
7 day motor function (FMA)0.205<0.001*0.390<0.001*
7 day ambulatory function (FAC)-2.279<0.001*
7 day swallowing fucntion (AHSA-NOMS)1.518<0.001*-
Pneumonia-11.3160.002*-73.613<0.001*
Respiratory failure-18.8020.003--
Initial hospitalization days-0.151<0.001*-

*p<0.05.

mRS. modified Rankin Scale; NIHSS, National Institutes of Health Stroke Scale; FMA, Fugl-Meyer Assessment; FAC, Functional Ambulatory Categories; ASHA-NOMS, Speech-Language-Hearing Association National Outcome Measurement System.

Figure 1. Distribution of 11 institutions that participated in the Korean Stroke Cohort Study

Figure 2. Comparison of stroke risk factors
*p<0.05

Figure 3. Comparison of initial stroke treatment
*p<0.05

Figure 4. The incidence of disability at six months after stroke onset
K-MBI, Korean version of Modified Barthel Index

Figure 5. Comparison of the active daily living function (K-MBI) of patients who received intensive rehabilitation during initial hospitalization
*p<0.05
REH, rehabilitation medicine departmentt; K-MBI, Korean version of Modified Barthel Index

Fig 1.

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Figure 1.Distribution of 11 institutions that participated in the Korean Stroke Cohort Study
Public Health Weekly Report 2022; 15: 435-449

Fig 2.

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Figure 2.Comparison of stroke risk factors
*p<0.05
Public Health Weekly Report 2022; 15: 435-449

Fig 3.

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Figure 3.Comparison of initial stroke treatment
*p<0.05
Public Health Weekly Report 2022; 15: 435-449

Fig 4.

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Figure 4.The incidence of disability at six months after stroke onset
K-MBI, Korean version of Modified Barthel Index
Public Health Weekly Report 2022; 15: 435-449

Fig 5.

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Figure 5.Comparison of the active daily living function (K-MBI) of patients who received intensive rehabilitation during initial hospitalization
*p<0.05
REH, rehabilitation medicine departmentt; K-MBI, Korean version of Modified Barthel Index
Public Health Weekly Report 2022; 15: 435-449
Comparison of patient characteristics between the 1st and 2nd Korean Stroke Cohorts
Characteristics1st Korean Stroke Cohort2nd Korean Stroke Cohort
Ischemic stroke (%)77.2%76.7%
Hemorrhagic stroke (%)22.8%23.3%
Mean age (year)65.1±13.567.0±13.3*
Previous functional level, normal (%)69.9%83.5%*
Comorbidity (CCAS ≥8)5.13±1.872.72±1.98*

*p<0.05.

CCAS, Combined condition and age-related score.
Comparison of initial treatment and rehabilitation therapy between the 1st and 2nd Korean Stroke Cohorts
Factors1st Korean Stroke Cohort2nd Korean Stroke Cohort
Patients admitted to Stroke Unit (%)48.9%62.7%*
Hospital day (day, mean±SD)18.0±23.215.1±27.6*
Consultation for Rehabilitation (%)75.1%85.7%*
Consultation for Rehabilitation (day)2.7±5.62.1±4.7*
Transfer to Rehabilitation department (%)16.5%19.7%*
Transfer to Rehabilitation department (day)16.8±14.813.4±13.7*

*p<0.05.
Multiple regression analysis of ischemic stroke patients three months after stroke onset
Factors1st Korean Stroke Cohort2nd Korean Stroke Cohort
β(p-value)β(p-value)
Age-0.268<0.001*-0.162<0.001*
Alcohol1.3080.014*-
CCAS--0.0500.035*
Premorbid mRS0.761<0.001*0.6360.003*
7 day stroke severity (NIHSS)--1.3140.004*
7 day cognitive function (K-MMSE)-1.706<0.001*-0.5520.007*
7 day motor function (FMA)0.173<0.001*0.258<0.001*
7 day ambulatory function (FAC)0.273<0.001*2.371<0.001*
7 day swallowing fucntion (AHSA-NOMS)1.120<0.001*-
7 day language function (K-FAST-SF)-0.3490.006*
Pneumonia-7.2260.002*-17.710<0.001*
Urinary tract infection-8.860<0.001*-
Initial hospitalization days-0.127<0.001*-
Intensive rehabilitation treatment5.357<0.001*4.1880.002*

*p<0.05.

CCAS, Combined condition and age-related score; mRS. modified Rankin Scale; NIHSS, National Institutes of Health Stroke Scale; FMA, Fugl-Meyer Assessment; FAC, Functional Ambulatory Categories; ASHA-NOMS, Speech-Language-Hearing Association National Outcome Measurement System; K-FAST-SF, Korean version of Frenchay Aphasia Screening Test Short Form.
Multiple regression analysis of hemorrhagic stroke patients three months after stroke onset
Factors1st Korean Stroke Cohort2nd Korean Stroke Cohort
β(p-value)β(p-value)
Age-0.465<0.001*-0.466<0.001*
Premorbid mRS1.2050.018*-
7 day stroke severity (NIHSS)-0.822<0.001*-
7 day motor function (FMA)0.205<0.001*0.390<0.001*
7 day ambulatory function (FAC)-2.279<0.001*
7 day swallowing fucntion (AHSA-NOMS)1.518<0.001*-
Pneumonia-11.3160.002*-73.613<0.001*
Respiratory failure-18.8020.003--
Initial hospitalization days-0.151<0.001*-

*p<0.05.

mRS. modified Rankin Scale; NIHSS, National Institutes of Health Stroke Scale; FMA, Fugl-Meyer Assessment; FAC, Functional Ambulatory Categories; ASHA-NOMS, Speech-Language-Hearing Association National Outcome Measurement System.

References

  1. Barker-Collo S, et al. Auckland stroke outcomes study: part 2: cognition and functional outcomes 5 years poststroke. Neurology 2010;75(18):1608-1616.
    Pubmed CrossRef
  2. 국가통계포털 https://kosis.kr/index/index.do, 2020
  3. Chang W.H., et al. Korean Stroke Cohort for functioning and rehabilitation (KOSCO): study rationale and protocol of a multicentre prospective cohort study. BMC Neurol 2015;15(1):1-7.
    Pubmed KoreaMed CrossRef
  4. Chang W.H., et al. Role of Intensive Inpatient Rehabilitation for Prevention of Disability after Stroke: The Korean Stroke Cohort for Functioning and Rehabilitation (KOSCO) Study. Brain & Neurorehabilitation 2016;9(2):1-10.
    CrossRef
  5. 안정훈 등. 보건의료 의사결정에서 비용-효과성에 관한 아시아 공동연구. 한국보건의료연구원 연구보고서 2012;1(1):1-76.
  6. 질병관리청한국뇌졸중재활코호트연구단. 우리나라 초발 뇌졸중 생존율과 후유장애 및 재활에 관한 10년 연구보고서 (2021).
  7. Veerbeek JM, Kwakkel G, van Wegen EE, Ket JC, Heymans MW. Early prediction of outcome of activities of daily living after stroke: a systematic review. Stroke; a journal of cerebral circulation 2011;42(5):1482-8.
    Pubmed CrossRef
  8. Parker VM, Wade DT, Langton Hewer R. Loss of arm function after stroke: measurement, frequency, and recovery. Int Rehabil Med 1986;8(2):69-73.
    Pubmed CrossRef
  9. Meijer R, van Limbeek J, Peusens G, et al. The Stroke Unit Discharge Guideline, a prognostic framework for the discharge outcome from the hospital stroke unit. A prospective cohort study. Clin Rehabil 2005;19(7):770-8.
    Pubmed CrossRef
  10. Kim BR, Han EY, Joo SJ, Kim SY, Yoon HM. Cardiovascular fitness as a predictor of functional recovery in subacute stroke patients. Disabil Rehabil 2014;36(3):227-31.
    Pubmed CrossRef

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