The Korean Stroke Cohort for Functioning and Rehabilitation (KOSCO)

Kang Sung Hyun, Choi Yong-Joo, Lee Kang Hee
Division of Chronic Disease Prevention, Center for Disease Prevention, KCDC
Kim Yun-Hee, Chang Won Hyuk, Shin Min-A
Samsung Medical Center, Sungkyunkwan University School of Medicine
Kim Deog Yung
Yonsei University College of Medicine
Lee Jongmin
Konkuk University School of Medicine
Sohn Min Kyun
Chungnam National University School of Medicine
Lee Sam-Gyu
Chonnam National University Medical School
Kim Soo-Yeon, Shin Yong-il
Pusan National University Yangsan Hospital
Lee Yang-Soo
Kyungpook National University School of Medicine, Kyungpook National University Hospital
Joo Min Cheol, Oh Gyung-Jae, Lee Young-Hoon
Wonkwang University
Han Eun Young
Jeju National University Hospital
Han Jun Hee
Hallym University
Ahn Jeonghoon
Ewha Womans University

Background: The incidence of stroke has increased, and stroke survivors are left with variable degree of residual disabilities, which confers 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 influencing residual disability and quality of life in stroke survivors.
Methods: The Korean Stroke Cohort for Functioning and Rehabilitation (KOSCO) is a prospective, multi-center, longitudinal follow-up study for investigating the survival and recurrence rates, functional status, mood, and quality of life in patients with ischemic or hemorrhagic first-ever stroke based on face-to-face assessments and interviews. We also conducted rehabilitation intervention studies to investigate the effects of early intensive rehabilitation therapies on long-term functional outcomes.
Results: Of 10,636 patients with first-ever stroke who were admitted to 9 hospitals nationwide, 7,858 patients who agreed to participate in the follow-up study were enrolled. This study maintained a follow-up rate higher than 70%, and it is currently conducting the 7th year of the 10-year planned study duration. By analyzing the follow-up dataset, the risk of mortality and recurrent vascular events were determined. The residual functional disabilities, health status, mood, and quality of life in stroke survivors were delineated as well. Factors influencing the residual disability and long-term quality of life in stroke survivors were also identified. In addition, we analyzed the cost-effectiveness of early intensive rehabilitation therapy in reducing residual disability after first-ever stroke.
Conclusion: These results provide useful information for establishing a comprehensive and structured stroke care system and national policy development on stroke management.

Keywords: Stroke, Incidence, Quality of life, Prospective studies, Follow-up studies