Date Presented 04/05/19
Identifying factors early in the rehabilitation process that predict the inability to return home independently after stroke may better inform treatment decisions. Therefore, we performed a secondary analysis to examine demographic, medical, and cognitive factors that might predict nonresponse during inpatient rehabilitation. Using a backward stepwise logistic regression, we found that the variables most strongly correlated with dependence were cognitive impairment and motor impairment.
Primary Author and Speaker: Sarah Walker
Contributing Authors: Elizabeth Skidmore, Lauren Terhorst
PURPOSE: Achieving independence with daily activities in the home after stroke is the ultimate goal for many stroke survivors and their caregivers. However, little is known about factors that predict inability to return home independently, largely due to conflicting results of research and a lack of evidence in practice (Galski et al., 1993, Bagg et al., 2002, Wee et al., 2005, Granger et al., 1992, Paolucci et al., 1996, Inouye et al., 2000). Identifying the characteristics of people in the rehabilitation process who are unlikely to meet this goal may inform treatment decisions. The purpose of this study is to identify variables that predict inability to return home independently from inpatient rehabilitation during stroke recovery. In this analysis, dependence refers to a score of less than 108 on the Functional Independence Measure (FIM).
DESIGN: This was a secondary analysis of data from 259 patients with cognitive impairment during inpatient rehabilitation. Data were combined from three studies examining meta-cognitive intervention for individuals with cognitive impairment post stroke.
METHODS: We examined demographic, medical, and cognitive factors that might predict non-response using the FIM. A backward stepwise logistic regression was performed using Statistical Packages for the Social Sciences (IBM SPSS Statistics, v.24) with a significance level of .05.
RESULTS: We found that the variables most correlated with dependence were cognitive impairment and motor impairment. Other variables analyzed included age, stroke severity, sex, race, education, type of stroke, hemisphere of stroke, mood, chronicity, and comorbidity. Our analyses showed that those with greater cognitive impairment (OR = 1.270; 95% CI= 1.129, 1.429; p<0.001) and motor impairment (OR= 1.338, 95% CI= 1.209, 1.484; p<0.001) have greater odds of being dependent versus independent.
CONCLUSION: Higher cognitive impairment and motor impairment may identify targets for treatment in the inpatient rehabilitation setting with the aim of increasing discharge FIM scores, ultimately increasing the number of people achieving independence at home after stroke.
References
Bagg, S., Pombo, A.P., Hopman, W. (2002). Effect of age on functional outcomes after stroke rehabilitation. Stroke, 33(1), 179-185. http://doi.org/10.1161/hs0102.101224
Galski, T., Bruno R.L., Zorowitz, R., Walker, J. (1993). Predicting length of stay, functional outcome, and aftercare in the rehabilitation of stroke patients. The dominant role of higher-order cognition. Stroke, 24(12), 1794-800. http://doi.org/10.1161/01.STR.24.12.1794
Granger, C.V., Hamilton, B.B., Fiedler, R.C. (1992). Discharge outcome after stroke rehabilitation. Stroke, 23(7), 978-82.
Wee, J.Y., Hopman, W.M. (2005). Stroke impairment predictors of discharge function, length of stay, and discharge destination in stroke rehabilitation. American Journal of Physical Medicine and Rehabilitation, 84(8), 604-12.
