SPEAK: Sequential prognostic evaluation of aphasia after stroKe: Prognosis and recovery
2012
Background The long-term functional outcome of
aphasia after stroke is uncertain, even though this
information is needed as early as possible for adequate
patient care and support. This observational prospective
study was aimed at predicting functional outcome at
1 year after stroke.
Methods We examined linguistic components
(ScreeLing) and functional verbal communication (Aphasia
Severity Rating Scale, ASRS) in 147 aphasic patients.
The ScreeLing was administered at 1, 2 and 6 weeks
after stroke; the ASRS at 1 week and 1 year. The
relationships between linguistic, demographic and stroke
characteristics, and good functional outcome at 1 year
(ASRS 4 or 5) were examined with logistic regression
analyses.
Results The baseline linguistic components (ie,
semantics, phonology and syntax) were significant
predictors (p<0.001) for 1-year outcome in univariable
analyses. In multivariable analysis, these variables
explained 46.5% of the variance, with phonology being
the only significant predictor (p=0.003). Age, Barthel
Index score, educational level and haemorrhagic stroke
were identified as other significant predictors of
outcome. A prognostic model of these five baseline
predictors explained 55.7% of the variance. The internally
validated area under the receiver operating characteristic
curve (AUC) was 0.89, indicating good predictive
performance. Adding the degree of phonological recovery
between 1 and 6 weeks after stroke to this model
increased the explained variance to 65% and the AUC to
0.91.
Conclusions The outcome of aphasia at 1 year after
stroke can be predicted in the first week by the
phonology score, the Barthel Index score, age,
educational level and stroke subtype, with phonology
being the strongest predictor.
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