Prognostic factors of functional outcome in post-acute stroke in the rehabilitation unit

Prognostic Factors Associated with Post-Stroke Dysphagia in Intracerebral Hemorrhage Patients

Spontaneous intracerebral hemorrhage (ICH) constitutes a significant portion of acute stroke incidents worldwide, often leading to post-stroke dysphagia (PSD), affecting 50-77% of survivors and worsening patient morbidity. This study aimed to identify predictive variables for PSD among patients with spontaneous ICH. A retrospective cohort study was conducted on adult patients with acute spontaneous ICH, confirmed by brain computed tomography, from June 2019 to June 2023. We analyzed demographic, neuroimaging, and stroke-specific characteristics and rehabilitation indicators. PSD was evaluated using nasogastric (NG) tube retention and the Functional Oral Intake Scale (FOIS) levels at 4 and 12 weeks post-ICH. Statistical analyses involved univariate and multivariate logistic regression to identify PSD predictors. A total of 310 ICH patients were included in the study. At 4 weeks, significant predictors for NG tube retention included 24-hour National Institute of Health Stroke Scale (NIHSS) scores, estimated glomerular filtration rate and sitting balance. At 12 weeks, hospital stay duration and ICH score were significant predictors for NG tube retention. Regarding the FOIS, significant predictors at 4 weeks included higher 24-hour NIHSS scores, compromised sitting balance, immobility-related complications, initial hematoma volume and intraventricular hemorrhages. At 12 weeks, older age and higher 24-hour NIHSS scores significantly predicted lower FOIS levels. Our findings demonstrate that PSD in ICH patients is influenced by a complex interplay of factors, including stroke severity, renal function, and physical impairment. The study highlights the importance of early neurological assessment, physical function, and comprehensive management in improving swallowing outcomes, emphasizing a multifaceted approach to enhancing outcomes for ICH survivors.

Use of the CHA2DS2-VASc score to predict subsequent myocardial infarction in atrial fibrillation

BACKGROUND

The risk of subsequent myocardial infarction (MI) varies widely in patients with atrial fibrillation (AF). No convenient scoring system currently exists to identify MI in AF. While each element of the CHA2DS2-VASc (congestive heart failure; hypertension; age ≥75 years [doubled]; type 2 diabetes; previous stroke or thromboembolism [doubled]; vascular disease; age 65-75 years; and sex category) score can increase the likelihood of MI, this retrospective longitudinal study aimed to determine the accuracy of the CHA2DS2-VASc score in predicting subsequent MI risk in AF.

METHODS

A total of 29,341 patients with AF were enrolled and followed up from January 2010 until the first occurrence of MI or until December 2020. The primary endpoint was the occurrence of subsequent MI.

RESULTS

The average age of the study population was 71 years, and 43.2% were male. The mean CHA2DS2-VASc score was found to be higher in patients with AF who had experienced an MI than in those who had not (3.56 ± 1.92 vs. 3.32 ± 1.81, p < 0.001). During the long-term follow-up, the risk of subsequent MI increased by 22% with every one-point increase in the CHA2DS2-VASc score (hazard ratio 1.22, 95% confidence interval 1.19-1.25; p < 0.001). Kaplan-Meier analysis revealed that high CHA2DS2-VASc scores were more likely to experience an MI than those with low CHA2DS2-VASc scores (log-rank p < 0.001). Furthermore, the CHA2DS2-VASc score was a significant predictor of MI in multivariate regression analysis.

CONCLUSION

The CHA2DS2-VASc score is a valuable predictor of subsequent MI risk in patients with AF.

Predicting the functional outcome of intensive inpatient rehabilitation after stroke: results from the RIPS Study

BACKGROUND

The complexity of stroke sequelae, the heterogeneity of outcome measures and rehabilitation pathways, and the lack of extensively validated prediction models represent a challenge in predicting stroke rehabilitation outcomes.

AIM

To prospectively investigate a multidimensional set of variables collected at admission to inpatient post-stroke rehabilitation as potential predictors of the functional level at discharge.

DESIGN

Multicentric prospective observational study.

SETTING

Patients were enrolled in four Intensive Rehabilitation Units (IRUs).

POPULATION

Patients were consecutively recruited in the period December 2019-December 2020 with the following inclusion criteria: aged 18+, with ischemic/haemorrhagic stroke, and undergoing inpatient rehabilitation within 30 days from stroke.

METHODS

This is a multicentric prospective observational study. The rehabilitation pathway was reproducible and evidence-based. The functional outcome was disability in activities of daily living, measured by the modified Barthel Index (mBI) at discharge. Potential multidimensional predictors, assessed at admission, included demographics, event description, clinical assessment, functional and cognitive profile, and psycho-social domains. The variables statistically associated with the outcome in the univariate analysis were fed into a multivariable model using multiple linear regression.

RESULTS

A total of 220 patients were included (median [IQR] age: 80 [15], 112 women, 175 ischemic). Median mBI was 26 (43) at admission and 62.5 (52) at discharge. In the multivariable analysis younger age, along with better functioning, fewer comorbidities, higher cognitive abilities, reduced stroke severity, and higher motor functions at admission, remained independently associated with higher discharge mBI. The final model allowed a reliable prediction of discharge functional outcome (adjusted R2=77.2%).

CONCLUSIONS

The model presented in this study, based on easily collectable, reliable admission variables, could help clinicians and researchers to predict the discharge scores of the global functional outcome for persons enrolled in an evidence-based inpatient stroke rehabilitation program.

CLINICAL REHABILITATION IMPACT

A reliable outcome prediction derived from standardized assessment measures and validated treatment protocols could guide clinicians in the management of patients in the subacute phase of stroke and help improve the planning of the rehabilitation individualized project.

Balance deficit is the domain of the Fugl-Meyer scale that best explain limitations in functional independence during hospitalization after a stroke

PURPOSE

To investigate which of the residual sensorimotor impairments, assessed by the Fugl-Meyer scale, would best explain functional independence during hospitalization after a stroke.

METHODS

This cross-sectional study retrieved data from medical records between January 2014 to December 2021. Explanatory independent variables were the following domains of the Fugl-Meyer scale: joint pain, joint range of motion, balance, sensory function, and motor function of the upper and lower limbs. Functional independence was measured by the Functional Independence Measure (FIM). Step-wise multiple linear regression analysis was used to identify which measures would explain functional independence (α=5%).

RESULTS

Data from 1,344 individuals, who had a mean age of 64 years, were retrieved. All included explanatory variables were significantly correlated with the FIM scores (0.24 ≤ r ≤ 0.87). Balance alone explained 76 % (F=4.24; p<0.001) of the variance in the FIM scores. When sensory function and upper-limb motor function scores were included in the model, the explained variance increased to 82 % (F = 1.935; p < 0.001).

CONCLUSIONS

Balance, which is important for carrying-out self-care activities, is the domain of the Fugl-Meyer scale that best explained functional independence during hospitalization after a stroke. Although sensory function and motor function of the upper limb added little to the explained variance, they should not be underlooked. Future research is needed to determine whether progressive balance training interventions would enhance functional independence after a stroke.

Usefulness of the GLIM criteria to predict recovery of activities of daily living in older adults with post-acute stroke

OBJECTIVES

The usefulness of malnutrition diagnosed using the Global Leadership Initiative on Malnutrition (GLIM) criteria as a predictor of recovery of activities of daily living is unclear. This study aimed to investigate whether baseline malnutrition diagnosed using the GLIM criteria was predictive of recovery of activities of daily living in older patients with post-acute stroke.

MATERIALS AND METHODS

A retrospective cohort study was conducted in patients aged ≥70 years with post-acute stroke. The outcome was activities of daily living measured using the motor domain of the Functional Independence Measure (FIM-motor) score at discharge. Participants were classified as malnourished or non-malnourished according to the GLIM criteria. Multivariate linear regression analyses were performed to determine whether baseline malnutrition diagnosed using the GLIM criteria was predictive of the FIM-motor score at discharge. The analysis was adjusted for clinically relevant covariates associated with rehabilitation outcomes after stroke.

RESULTS

A total of 236 patients (mean age, 80.0 years; female, 54.2%) were included in the analysis. On admission, 83 (35.2%) patients were diagnosed with malnutrition. Multivariate linear regression analyses showed that malnutrition diagnosed using the GLIM criteria was predictive of the FIM-motor score at discharge (β = -0.347, P < 0.001).

CONCLUSIONS

Identifying malnutrition using the GLIM criteria is useful for predicting recovery of activities of daily living in older patients with post-acute stroke.

Association between Vitamin D and Short-Term Functional Outcomes in Acute Ischemic Stroke

Vitamin D (Vit D) affects musculoskeletal performance and central nervous system neuroprotection. We aimed to investigate the association between serum Vit D levels and short-term functional outcomes in patients with acute ischemic stroke. This study involved patients with acute ischemic stroke confirmed on brain MRI. The National Institutes of Health Stroke Scale (NIHSS) was used to assess initial stroke severity upon admission. We evaluated the functional outcomes using the Berg Balance Scale (BBS), Manual Function Test (MFT), Korean Mini-Mental State Examination (K-MMSE), Korean version of the modified Barthel Index (K-MBI) within three weeks from the onset of stroke, and modified Rankin Scale (mRS) score at discharge. Overall, 192 patients were finally included and divided into three groups: Vit D sufficient (n = 28), insufficient (n = 49), and deficient (n = 115). Multivariate analysis showed that the Vit D deficient group presented with a higher risk of initially severe stroke (p = 0.025) and poor functional outcomes on the BBS (p = 0.048), MFT (p = 0.017), K-MMSE (p = 0.001), K-MBI (p = 0.003), and mRS (p = 0.032) compared to the Vit D sufficient group. Vit D deficiency may be associated with severe initial stroke and poor short-term post-stroke functional outcomes.

Over- and under-supply of inpatient rehabilitation after stroke without a post-acute rehabilitation system: a nationwide retrospective cohort study

Introduction

This study aimed to investigate the utilization of post-ischemic stroke rehabilitation prior to the introduction of the post-acute rehabilitation system in South Korea in 2017.

Methods

Medical resources utilized for patients with cerebral infarction hospitalized at Regional Cardio-Cerebrovascular Centers (RCCVCs) of 11 tertiary hospitals were tracked until 2019. Stroke severity was classified according to the National Institutes of Health Stroke Scale (NIHSS), and multivariate regression analysis was performed to analyze factors influencing the length of hospital stay (LOS).

Results

This study included 3,520 patients. Among 939 patients with stroke with moderate or greater severity, 209 (22.3%) returned home after RCCVC discharge without inpatient rehabilitation. Furthermore, 1,455 (56.4%) out of 2,581 patients with minor strokes with NIHSS scores ≤4 were readmitted to another hospital for rehabilitation. The median LOS of patients who received inpatient rehabilitation after RCCVC discharge was 47 days. During the inpatient rehabilitation period, the patients were admitted to 2.7 hospitals on average. The LOS was longer in the lowest-income group, high-severity group, and women.

Conclusion

Before the introduction of the post-acute rehabilitation system, treatment after stroke was both over- and under-supplied, thus delaying home discharge. These results support the development of a post-acute rehabilitation system that defines the patients, duration, and intensity of rehabilitation.

Sodium-Glucose Cotransporter-2 Inhibitor Prevents Stroke in Patients With Diabetes and Atrial Fibrillation

Background Atrial fibrillation (AF) is associated with increasing risk of thromboembolic or ischemic stroke. The CHA₂DS₂-VASc score is a well-established predictor of AF stroke. Patients with AF have an increased risk of stroke if they have diabetes. Use of sodium-glucose cotransporter-2 inhibitor (SGLT2i) has been shown to be associated with favorable cardiovascular outcomes in patients with diabetes. It was unknown whether use of SGLT2i decreased stroke risk in patients with AF who have diabetes. Methods and Results A total of 9116 patients with AF and diabetes from the National Taiwan University historical cohort were longitudinally followed up for 5 years (January 2016-December 2020). The risk of stroke related to SGLT2i use was evaluated by Cox model, adjusting CHA₂DS₂-VASc score in the propensity score-matched population with 474 SGLT2i users and 3235 nonusers. Adverse thromboembolic end points during follow-up were defined as ischemic stroke. The mean age was 73.2±10.5 years, and 61% of patients were men. There were no significant differences of baseline characteristics between users and nonusers of SGLT2i, including CHA₂DS₂-VASc score in the propensity score-matched population. The stroke rate was 3.4% (95% CI, 2.8-4.2) patient-years in SGLT2i users and 4.3% (95% CI, 4.0-4.6) in nonusers (P=0.021). SGLT2i users had a 20% reduction of stroke (hazard ratio, 0.80 [95% CI, 0.64-0.99]; P=0.043) after adjustment for the CHA₂DS₂-VASc score. Conclusions Use of SGLT2i was associated with a lower stroke risk in patients with diabetes and AF, and it may be considered to escalate SGLT2i to the first-line treatment in patients with diabetes and AF.

Association of clinical factors to functional outcomes in patients with stroke with large-vessel occlusion after endovascular thrombectomy

BACKGROUND/PURPOSE

Multiple clinical factors have been reported to be associated with functional outcomes in patients with stroke. However, little is known about prognostic predictors of functional independence in patients with stroke undergoing endovascular thrombectomy (EVT). Our study aimed to investigate the correlation between multiple prognostic variables (including EVT and rehabilitation-related parameters) and functional outcomes in patients post-EVT.

METHODS

This retrospective cohort study recruited patients hospitalized between December 2018 and March 2022. Patients with stroke with large-vessel occlusion who underwent EVT were eligible for inclusion in the study. Prognostic factors, including premorbid characteristics, laboratory data, EVT- and rehabilitation-related parameters, functional activity level, balance ability, swallowing, and sphincter function, were collected. Logistic regression and generalized linear models were used to analyze their correlations with functional outcomes.

RESULTS

A total of 148 patients were included. In the univariate logistic regression analysis, younger age, premorbid functional independence, higher hemoglobin (Hb) level, lower National Institute of Health Stroke Scale (NIHSS) score, absence of hemorrhagic transformation in 14 days, no nasogastric (NG) tube placement, earlier rehabilitation, frequent daily rehabilitation sessions, more out-of-bed rehabilitation, better ability of sitting up, better initial sitting balance, higher Barthel index (BI), absence of immobility, and neurological complications were associated with favorable outcomes at 3 months. In the stepwise regression model, the predictors of favorable function at 3 months included age, ability to sit up, and frequency of daily rehabilitation sessions; favorable outcomes at 6 months were associated with age, ability to sit up, and swallowing function.

CONCLUSION

In patients with stroke post-EVT, better functional outcomes were associated with prognostic variables, including younger age, better ability to sit up, normal swallowing function, and frequent daily rehabilitation sessions.

Application of an Artificial Neural Network to Identify the Factors Influencing Neurorehabilitation Outcomes of Patients with Ischemic Stroke Treated with Thrombolysis

The administration of thrombolysis usually reduces the risk of death and the consequences of stroke in the acute phase. However, having received thrombolysis administration is not a prognostic factor for neurorehabilitation outcome in the subacute phase of stroke. It is conceivably due to the complex intertwining of many clinical factors. An artificial neural network (ANN) analysis could be helpful in identifying the prognostic factors of neurorehabilitation outcomes and assigning a weight to each of the factors considered. This study hypothesizes that the prognostic factors could be different between patients who received and those who did not receive thrombolytic treatment, even if thrombolysis is not a prognostic factor per se. In a sample of 862 patients with ischemic stroke, the tested ANN identified some common factors (such as disability at admission, age, unilateral spatial neglect), some factors with higher weight in patients who received thrombolysis (hypertension, epilepsy, aphasia, obesity), and some other factors with higher weight in the other patients (dysphagia, malnutrition, total arterial circulatory infarction). Despite the fact that thrombolysis is not an independent prognostic factor for neurorehabilitation, it seems to modify the relative importance of other clinical factors in predicting which patients will better respond to neurorehabilitation.

The prognostic value of the Barthel Index for mortality in patients with COVID-19: A cross-sectional study

Objective

This study aimed to analyze the association between the activity of daily living (ADL), coronavirus disease (COVID-19), and the value of the Barthel Index in predicting the prognosis of patients.

Methods

This study included 398 patients with COVID-19, whose ADL at admission to hospital were assessed with the Barthel Index. The relationship between the index and the mortality risk of the patients was analyzed. Several regression models and a decision tree were established to evaluate the prognostic value of the index in COVID-19 patients.

Results

The Barthel Index scores of deceased patients were significantly lower than that of discharged patients (median: 65 vs. 90, P < 0.001), and its decrease indicated an increased risk of mortality in patients (P < 0.001). After adjusting models for age, gender, temperature, pulse, respiratory rate, mean arterial pressure, oxygen saturation, etc., the Barthel Index could still independently predict prognosis (OR = 0.809; 95% CI: 0.750-0.872). The decision tree showed that patients with a Barthel Index of below 70 had a higher mortality rate (33.3-40.0%), while those above 90 were usually discharged (mortality: 2.7-7.2%).

Conclusion

The Barthel Index is of prognostic value for mortality in COVID-19 patients. According to their Barthel Index, COVID-19 patients can be divided into emergency, observation, and normal groups (0-70; 70-90; 90-100), with different treatment strategies.

Relationship between Incontinence and Disease Severity in Patients Transported by Ambulance

Introduction

Retrospectively investigated this relationship using data from Shimoda Fire Department.

Methods

We investigated patients who were transported by Shimoda Fire Department from January 2019 to December 2021. The participants were divided into groups based on the existence of incontinence at the scene or not (Incontinence [+] and Incontinence [-]). We compared the variables mentioned above between these groups.

Results

There were 499 cases with incontinence and 8241 cases without incontinence. There were no significant differences between the two groups with respect to weather and wind speed. The average age, percentage of male patients, percentage of cases in the winter season, rate of collapse at home, scene time, rate of endogenous disease, disease severity, and mortality rate in the incontinence (+) group were significantly greater in comparison to the incontinence (-) group, whereas the average temperature in the incontinence (+) group was significantly lower than that in the incontinence (-) group. Regarding the rates of incontinence of each disease, neurologic, infectious, endocrinal disease, dehydration, suffocation, and cardiac arrest at the scene had more than twice the rate of incontinence in other conditions.

Conclusions

This is the first study to report that patients with incontinence at the scene tended to be older, showed a male predominance, severe disease, high mortality, and required a long scene time in comparison to patients without incontinence. Prehospital care providers should therefore check for incontinence when evaluating patients.

Risk factors for unfavorable clinical course of the early recovery period of ischemic stroke in young and middle-aged patients

Background. This study was carried out due to persistent increase in the incidence of ischemic stroke in people of working age and insufficient knowledge of risk factors affecting its clinical course in the early recovery period in young and middle-aged patients.The aim. To identify and to study variants of the clinical course of the early recovery period of ischemic stroke in young and middle-aged patients; to determine the risk factors for its unfavorable course.Materials and methods. We carried out a longitudinal prospective study, which involved 145 patients with ischemic stroke in its early recovery period. The main risk factors for cardiovascular diseases were analyzed. Dynamic observation of these patients allowed us to determine five variants of the clinical course of the ischemic stroke early recovery period – regressive, regressive with residual mild focal neurological symptoms, stable, slowly progressive and rapidly progressive.Results. Regressive course was observed in 58 (40 %) patients; regressive course with residual mild focal neurological symptoms – in 66 (45.5 %) patients; stable course – in 9 (6.2 %) patients; slowly progressive course – in 8 (5.5 %) patients, rapidly progressive course – in 4 (2.8 %) patients. The following risk factors had statistically significant affect on the unfavorable course of the disease: more pronounced motor, sensory and speech disorders at the time of patient’s admission to the hospital and at the end of the ischemic stroke early recovery period; severity of ischemic stroke according to the National Institutes of Health Stroke Scale (NIHSS); damage to the carotid basin of the brain; ischemic heart disease; irregular intake or patient’s refuse of taking prescribed antiplatelet, lipid-lowering, antihypertensive therapy (p < 0.05).Conclusions. Defining the variant of the clinical course of the ischemic stroke early recovery period in young and middle-aged patients and risk factors for its unfavorable course is important in determining tactics and further neurorehabilitation measures.

Functional outcome prediction of ischemic stroke patients with atrial fibrillation accepting post-acute care training

Background

Ischemic stroke poses a major threat to human health and represents the third leading cause of death worldwide and in Taiwan. Post-acute care (PAC) training has been reported to be beneficial for post-index stroke events. However, knowledge is still lacking on the outcome of stroke events with cardiac origin. The focus of the current study is to investigate the effectiveness of PAC in this subgroup of patients as well as identify key baseline pointers that are capable of early prediction of patients' physical recovery. In addition, the authors hypothesize that the routinely arranged non-invasive carotid duplex that evaluates the characteristics of the carotid lumen could play a significant role in providing an early outcome prediction.

Methods

For the current research, 142 ischemic stroke patients with underlying cardiac arrhythmia (atrial fibrillation) were retrospectively recruited. The patients' basic demographics, neuroimaging, carotid duplex, and basic biochemistry datasets were accurately documented. The pre and post-admission National Institutes of Health Stroke Scale (NIHSS) (6-month follow-ups), Barthel Index, and mRS score (12-month follow-ups) were also recorded. All statistical analyses were performed using R for Windows (version 3.6.3). Barthel Index, NIHSS, and mRS scores obtained before and after hospitalization were compared to determine the patients' outcomes and were classified as improved or unimproved. A multivariate logistic analysis was designed and applied to assess the significance of risk factors and to obtain the odds ratios (ORs). The receiver operating characteristic (ROC) curve and the Youden Index was used to find the important cut-off point information, and the area under the curve (AUC) was calculated to provide accuracy.

Results

The average age of the 142 ischemic stroke patients enrolled in the current study was about 66 years, of which 88 patients were male and 54, female. Many of them had other comorbidities: 86 patients had mixed hyperlipidemia (60.56%), 115 had hypertension (80.99%), and 49 suffered from diabetes mellitus (34.51%). The mRS showed an improvement in the condition of only 40 patients (28.175%), whereas the Barthel Index showed improvement in 71 patients (50%), and 68 patients (47.89%) showed recovery on the NIHSS. The Barthel Index and NIHSS were selected because they already had an almost equal number of samples among the improved and unimproved groups (50%), rather than mRS, which had a lower number (28.17%) of improved cases. While conducting the EuroQol-5 Dimension (EQ-5D) assessment, anxiety/depression stood out as the most prominent issue, affecting 44 patients (30.99%). Self-care was another factor that was involved in the ongoing improvement of 36 patients (25.35%). Multivariate logistic analysis of both NIHSS and Barthel Index showed improvement with a contralateral plaque index statistical significance (P&lt;0.05), whereas NIHSS showed a relevant significance in anxiety/depression and Barthel Index registered usual activity in the data analysis (P&lt;0.05). ROC curve and Youden index analysis showed similar results in both NIHSS and Barthel Index of contralateral plaque index of 4.5, this being the cutoff point value for this group of patients.

Conclusion

In the current study, nearly half of the enrolled patients showed favorable functional recovery. The outcome assessments seem to correlate well with NIHSS and Barthel Index scores, rather than mRS. The anxiety/depression and usual activities domains of the EQ-5D results are associated with and have a great impact after the patients undertake the PAC rehabilitative strategy. Moreover, the variables obtained through carotid duplex and plaque index might also play a significant role in determining the patient's functional outcome.

Leveraging Factors of Self-Efficacy and Motivation to Optimize Stroke Recovery

The International Classification of Functioning, Disability and Health framework recognizes that an individual's functioning post-stroke reflects an interaction between their health condition and contextual factors encompassing personal and environmental factors. Personal factors significantly impact rehabilitation outcomes as they determine how an individual evaluates their situation and copes with their condition in daily life. A key personal factor is self-efficacy-an individual's belief in their capacity to achieve certain outcomes. Self-efficacy influences an individual's motivational state to execute behaviors necessary for achieving desired rehabilitation outcomes. Stroke rehabilitation practice and research now acknowledge self-efficacy and motivation as critical elements in post-stroke recovery, and increasing evidence highlights their contributions to motor (re)learning. Given the informative value of neuroimaging-based biomarkers in stroke, elucidating the neurological underpinnings of self-efficacy and motivation may optimize post-stroke recovery. In this review, we examine the role of self-efficacy and motivation in stroke rehabilitation and recovery, identify potential neural substrates underlying these factors from current neuroimaging literature, and discuss how leveraging these factors and their associated neural substrates has the potential to advance the field of stroke rehabilitation.

Prognostic Factors in Neurorehabilitation of Stroke: A Comparison among Regression, Neural Network, and Cluster Analyses

There is a large body of literature reporting the prognostic factors for a positive outcome of neurorehabilitation performed in the subacute phase of stroke. Despite the recent development of algorithms based on neural networks or cluster analysis for the identification of these prognostic factors, the literature lacks a rigorous comparison among classical regression, neural network, and cluster analysis. Moreover, the three methods have rarely been tested on a sample independent from that in which prognostic factors have been identified. This study aims at providing this comparison on a wide sample of data (1522 patients) and testing the results on an independent sample (1000 patients) using 30 variables. The accuracy was similar among regression, neural network, and cluster analyses on the analyzed sample (76.6%, 74%, and 76.1%, respectively), but on the test sample, the accuracy of neural network decreased (70.1%). The three models agreed in identifying older age, severe impairment, unilateral spatial neglect, and total anterior circulation infarcts as important prognostic factors. The binary regression analysis also provided solid results in the test sample, especially in terms of specificity (81.8%). Cluster analysis also showed a high sensitivity in the test sample (82.6%) and allowed a meaningful easy-to-use classification tree to be obtained.