Stroke commonly results in a complex neurological impairment, consisting of sensorimotor, cognitive, psychological and behavioural impairment (Carr and Sheperd 1998). Thus, surviving from stroke means living with some forms of disabilities. Stroke has been long regarded as a dominant cause of morbidity and long term disability throughout the world (Lopez et al. 2001). It is well established that between 37% to 62% of stroke survivors will live with long term residual physical, cognitive and psychological impairments, so many suffer from mental and physical disabilities (Duncan 1994, American Heart Association 1998), ranging from mild to severe.
Reduced mobility as a result of post-stroke disabilities often leads to functional decline and increased hospitalization, due to associated medical complications such as respiratory infection, urinary tract infection and pressure ulcers, or recurrence of stroke (The European Stroke Organisation 2008, Australian Stroke Foundation 2005). The decline in function increases in the longer term at a rate of 9% annually over 5 years, with the greatest decline beginning 3 years after the stroke (Dhamoon et al. 2009). Added to this, most individuals with stroke being elderly, are exposed to accelerated decline in function. In a longer term, persistent mobility problem may result in greater burden to the stroke survivors, the family and the society.
Individuals who survive the acute episode of stroke still have the risk for death. The cumulative risks for death at 28 days, 1 year, and 5 years after onset were estimated at 28%, 41%, and 60%, respectively. Compared with the general population, stroke was associated with an almost 5-fold increase in risk for death between 4 weeks and 1 year after a first stroke and a 2-fold increase in the risk for death subsequent to 1 year (Bronnum-Hansen et al 2001).
Stroke survivors also have a high risk of recurrence of stroke, i.e. 13% or 15 times more than the general population, especially among those with multiple stroke risk factors (Burn et al. 1994). The overall stroke recurrence rates were around 5% per year, with cumulative rates of 5.7%, 19.3% and 28.8% at 1, 5 and 10 years post-stroke respectively (Hier et al 1991).