The Role of Prognostic Scores in Targeting Stroke Rehabilitation in Elderly Patients

OBJECTIVE: To determine the validity of clinically derived prognostic scores in targeting stroke rehabilitation in elderly patients. DESIGN, SETTING AND PARTICIPANTS: One-year prospective cohort study in 96 hospitalized stroke patients over 75 years of age from a well defined geographical area. MEASUREMENTS: Edinburgh prognostic score (incorporating measures of motor deficit, proprioception, and power), Orpington prognostic score (Edinburgh score modified to include a measure of cognition), and Barthel ADL scores were measured at 1, 2, and 4 weeks after stroke. These scores were correlated with outcome and patients' Barthel ADL score at discharge or at 16 weeks if still in hospital. RESULTS: Edinburgh prognostic score measured at 2 weeks correlated significantly with Barthel ADL score at discharge or at 16 weeks (r2 = 0.57, P 5.2 required long-term care. Most patients (90%) with Orpington Score of 3-5 were eventually discharged home although this was not always apparent on initial clinical assessment at the time of admission. CONCLUSIONS: The Orpington score when assessed at 2-weeks post-stroke is a useful prognostic indicator with special suitability for the elderly and may help to select patients most likely to benefit from stroke unit rehabilitation.