Category: Stroke; Measurement
To better understand activities limitations (AL) recovery after inpatient stroke rehabilitation (ISR) using assessments sensitive to change and without appreciable ceiling effects.
Design : Data analysis from a prospective, observation database
Setting : Urban, academic ISR unit
Participants (or Animals, Specimens, Cadavers) : 88/272 (32%) of discharges had complete data with a mean age=68.1+14.1y, National Institutes of Health Stroke Score (NIHSS)=8.0+8.0, rehabilitation length of stay =14.8+7.4d and discharge functional independence measure (dFIM) score=84.5+19.3. Fifty-three percent were male, 41% had right hemispheric lesions and 23% a previous stroke. The 88 with data had a slightly higher NIHSS and dFIM scores (both p=.051.)
Interventions : None
Main Outcome Measure(s) : Activity Measure-Post Acute Care (AM-PAC) Basic Mobility (BM), Daily Activity (DA) and Applied Cognition (AC) domains were collected at discharge from (D/C) and 6M and 12M after ISR stay from either patient or family/therapist proxy. Changes in raw domains scores were analyzed by ANOVA and post-hoc paired t-tests.
Results : Raw scores across DC, 6M and 12M were 52.1, 56.1 and 55.3 for BM (F=1994.1, p
Conclusions : Our data suggest recovery of BM, DA and AC only during the DC to 6M period with a slight decline from 6M to 12M, statistically significant only for AC. Strategies are needed to monitor AL post- ISR discharge and implement “booster” treatment when decline is noted. Limitations include a relatively small sample size at a single institution with a high dropout rate. Future research should examine predictors of functional outcomes at 6M and 12M.
Michael O'Dell– Professor, Vice-Chair of Clinical Services, Weill Cornell Medicine, New York, New York
Megan Frantz– Participant Physician, Kaiser Foundation Rehabilitation Center, Lafayette, California
Ruchi Patel– senior occupational therapist, New York Presbyterian Weill Cornell, Brooklyn, New York
Angela Nunez– Research Assistant, Weill Cornell Medicine, NY, New York
Joan Toglia– Professor and Dean, Mercy College, Dobbs Ferry, New York
Abhishek Jaywant– Assistant Professor, Weill Cornell Medicine, New York, New York