Participation in Rehabilitation and Activities of Daily Living at Hospital Admission as Predictors of Post-Stroke Improvement in ADL: A Retrospective Cohort Study

Abstract

Background

Most measures of rehabilitation participation rely on self-report, excluding patients with cognitive impairment or aphasia. The observational Pittsburgh Rehabilitation Participation Scale (PRPS) allows their inclusion; however, whether rehabilitation participation assessed using the PRPS modifies improvement in activities of daily living (ADL) remains unclear.

Objective

To determine whether rehabilitation participation assessed using the PRPS modifies the association between baseline ADL and subsequent improvement after stroke.

Methods

This retrospective cohort study included 137 stroke survivors in a subacute rehabilitation ward. Admission rehabilitation participation was assessed by the PRPS. ADL improvement was evaluated using the Functional Independence Measure (FIM) motor effectiveness score. Hierarchical multiple regression analysis included age, days from onset to hospital admission, admission FIM motor and cognitive scores, and admission PRPS score in Step 1, followed by the PRPS × admission FIM motor interaction term in Step 2. Prediction plots were generated for each PRPS score.

Results

The median admission PRPS and FIM motor effectiveness scores were 5 (interquartile range [IQR], 4–6) and 0.70 (IQR, 0.33–0.88), respectively. Adding the PRPS × FIM motor interaction term in Step 2 significantly improved the model fit (ΔR² = 0.057, ΔF(1,130) = 16.28, p < .001), resulting in a final model (R² = 0.545, p < .001). Prediction plots showed steeper slopes with higher PRPS scores.

Conclusions

Admission rehabilitation participation assessed by the PRPS modified the association between baseline ADL and ADL improvement. Observable participation should be interpreted in relation to baseline motor ADL rather than in isolation. Lower participation may indicate a need for additional clinical support.