Relationship among Sex, Pattern of Weakness and Treatment Outcomes of Post-Stroke Patients: A Register-Based Longitudinal Study

Keywords: Health outcome, Right sided-weakness, Sex difference, Stroke, Stroke rehabilitation


Introduction: Differences in stroke care and health outcomes between males and females are debated globally. Sex differences in functional outcomes after stroke rehabilitation are poorly investigated in the context of Nepal. This study aimed to explore the relationship among patients’ sex, side of weakness, and post-stroke health outcomes after rehabilitation in a hilly western region of Nepal. Methods: A register-based longitudinal study was conducted in a rehabilitation center including all consecutive patients with stroke who came for rehabilitation ( ayurvedic, homeopathic, acupuncture, and physiotherapy ) from March 2018 to March 2020.
Modified Rankin Scale score at a three-month follow-up after a visit to the center was the main outcome measure. It was reported using relative risk and 95% confidence intervals. Results: The study included 384 stroke patients, among them 241 (62.8%) were males. Right-sided weakness was 1.262 times (RR =1.262, 95% CI = 1.016-1.567) more likely in males than in females. Male stroke patients were 1.104 times more likely to achieve a good outcome than females (RR=1.104, 95% CI = 1.007-1.211) and these findings were statistically significant. There was no association between the side of weakness and the outcome. Conclusion: More males,
compared to females, visited for rehabilitation and achieved a good outcome (mRS0-2) after three months. Right-sided weakness was more common in males than in females.


Download data is not yet available.

Author Biographies

Shaligram Chaudhary, Lumbini Medical College and Teaching Hospital


Department of Physiology.

Lok Raj Joshi, Lumbini Medical College and Teaching Hospital


Department of Physiology.

Bibek Koju, Lumbini Medical College and Teaching Hospital

Assistant Professor,

Department of Physiology.


GBD 2016 Stroke Collaborators. Global, regional, and national burden of stroke, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet Neurol. 2019;18(5):439-58. PMID: 30871944 DOI:

World Life expectancy. Nepal: Stroke [Internet].Available from: [cited 1st Jul 2020]

Jwarchan B, Yogi N, Adhikari S, Bhandari P, Lalchan S. A Study of Prevalence and Predictors of Acute Ischemic CVA Patients Admitted to Manipal Teaching Hospital, Pokhara, Nepal. Eastern Green Neurosurgery. 2020;2(1):42-6. DOI:

Haast RAM, Gustafson DR, Kiliaan AJ. Sex differences in stroke. J Cereb Blood Flow Metab. 2012;32(12):2100-7. PMID: 23032484DOI:

Kes VB, Jurašić MJ, Zavoreo I, Lisak M, Jelec V, Matovina LZ. Age and Gender Differences in Acute Stroke Hospital Patients. Acta clin Croat. 2016;55(1):69-78. PMID: 27333721DOI:

Hametner C, Ringleb P, Kellert L. Sex and Hemisphere - A Neglected, Nature-Determined Relationship in Acute Ischemic Stroke. Cerebrovasc Dis. 2015;40(1–2):59-66. PMID: 26184600DOI:

Gall S, Phan H, Madsen TE, Reeves M, Rist P, Jimenez M, et al. Focused Update of Sex Differences in Patient Reported Outcome Measures After Stroke. Stroke. 2018;49(3):531-5. PMID: 29438087DOI:

Hedna VS, Bodhit AN, Ansari S, Falchook AD, Stead L, Heilman KM, et al. Hemispheric Differences in Ischemic Stroke: Is Left-Hemisphere Stroke More Common? J Clin Neurol. 2013;9(2):97-102. PMID: 23626647DOI:

Renoux C, Coulombe J, Li L, Ganesh A, Silver L, Rothwell PM, et al. Confounding by Pre-Morbid Functional Status in Studies of Apparent Sex Differences in Severity and Outcome of Stroke.Stroke.2017;48(10):2731-8.PMID: 28798261DOI:

Willers C, Lekander I, Ekstrand E, Lilja M, Pessah-Rasmussen H, Sunnerhagen KS, et al. Sex as predictor for achieved health outcomes and received care in ischemic stroke and intracerebral hemorrhage: a register-based study. Biol Sex Differ. 2018;9(1):11.PMID: 29514685DOI:

Girijala RL, Sohrabji F, Bush RL. Sex differences in stroke: Review of current knowledge and evidence. Vasc Med. 2017;22(2):135-45.PMID: 27815349 DOI:

Poggesi A, Insalata G, Papi G, Rinnoci V, Donnini I, Martini M, et al. Gender differences in post-stroke functional outcome at discharge from an intensive rehabilitation hospital. Eur J Neurol. 2021;28(5):1601-8. PMID: 33561883DOI:

Sacco RL, Kasner SE, Broderick JP, Caplan LR, Connors JJB, Culebras An, et al. An Updated Definition of Stroke for the 21st Century: a statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2013;44(7):2064-89.PMID: 23652265DOI:

Specifications Manual for Joint Commission National Quality Measures (v2018A). Modified Rankin Score (mRS) [Internet].Available from: [cited 8th June 2020]

Thapa A, Kc B, Shakya B, Yadav DK, Lama K, Shrestha R. Changing Epidemiology of Stroke in Nepalese Population. Nepal Journal of Neuroscience. 2018;15(1):10-18. DOI:

Hiraga A. Gender Differences and Stroke Outcomes. Neuroepidemiology. 2017;48(1–2):61–2. PMID: 28419999 DOI:

Wang Q, Mejía-Guevara I, Rist PM, Walter S, Capistrant BD, Glymour MM. Changes in Memory Before and After Stroke Differ by Age and Sex, but not by Race. Cerebrovasc Dis. 2014;37(4):235-43.PMID: 24686293DOI:

Silasi G, Murphy TH. Stroke and the Connectome: How Connectivity Guides Therapeutic Intervention. Neuron. 2014;83(6):1354-68. PMID: 25233317DOI:

Towfighi A, Ovbiagele B, El Husseini N, Hackett ML, Jorge RE, Kissela BM, et al. Poststroke Depression: A Scientific Statement for Healthcare Professionals From the American Heart Association/American Stroke Association. Stroke. 2017;48(2):e30-43.PMID: 27932603DOI:

Phan HT, Blizzard CL, Reeves MJ, Thrift AG, Cadilhac D, Sturm J, et al. Sex Differences in Long-Term Mortality After Stroke in the INSTRUCT (INternational STRoke oUtComes sTudy): A Meta-Analysis of Individual Participant Data. Circ Cardiovasc Qual Outcomes.2017;10(2):e003436.PMID: 28228454DOI:

Cordonnier C, Sprigg N, Sandset EC, Pavlovic A, Sunnerhagen KS, Caso V, et al. Stroke in women - from evidence to inequalities. Nat Rev Neurol. 2017;13(9):521-32.PMID: 28731036DOI:

Carcel C, Woodward M, Wang X, Bushnell C, Sandset EC. Sex matters in stroke: A review of recent evidence on the differences between women and men. Front Neuroendocrinol. 2020;59:100870.PMID: 32882229DOI:

Bushnell C, Howard VJ, Lisabeth L, Caso V, Gall S, Kleindorfer D, et al. Sex differences in the evaluation and treatment of acute ischaemic stroke. Lancet Neurol. 2018;17(7):641-50. PMID: 29914709DOI:

How to Cite
Chaudhary S, Joshi L, Koju B. Relationship among Sex, Pattern of Weakness and Treatment Outcomes of Post-Stroke Patients: A Register-Based Longitudinal Study. J Lumbini Med Coll [Internet]. 4Aug.2022 [cited 2Dec.2023];10(1):7 pages. Available from:
Original Research Article