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Functional outcomes in inpatient rehabilitative care of stroke patients:predictive factors and the effect of therapy intensity

SK Saxena

Background The knowledge of factors predicting functional recovery and the optimum amount of therapy given to stroke patients is crucial for predicting and achieving best possible outcomes.Objectives To evaluate factors predicting activities of daily living (ADL) dependency upon planned discharges and the effect of intensity of therapy during inpatient rehabilitation of stroke patients.Methodology Observational study of 200 stroke patients in two community (rehabilitation) hospitals. Assessments were made on admission and discharge that included functional and neurological impairment, depression, cognitive impairment and medical chart data on total hours of therapy. Results On admission and on discharge, 54% and19% respectively of the patients were ADL dependent. In multivariate analyses, the independent significant predictors were cognitive impairment (hazard ratio (HR) = 4.11, 95% confidence interval (CI) 1.41, 11.95), ADL dependency upon admission  (HR = 9.76, 95% CI 1.28, 74.12), severe neurological impairment on admission (HR = 2.70, 95% CI 1.31, 5.53) and recurrent stroke (HR = 2.89, 95% CI 1.31, 5.53). Adjusted for these variables, each hour  of therapy significantly reduced the risk of ADL dependency at discharge.Conclusion Functional recovery in stroke patientsis predicted by clinical and neurological factors and by the intensity of therapy.