Abstract 203: Community Based Outpatient Stroke Rehabilitation Program Achieves Excellent Outcomes Including Return to Work, Driving, Improved Blood Pressure Control, and Other Rehabilitation Outcomes

Abstract

Background: Return to Driving and Employment are goals for many stroke survivors. These person-centered goals are often the motivators for participation in outpatient rehabilitation. However, standardized measure sets and patient assessments are not in place or required for outpatient rehabilitation programs. As such, few outpatient rehabilitation programs measure and report patient centered outcomes like return to work or employment in addition to functional status and disease management measures. Methods: Prospective observational study of recovery of stroke patients treated between 12/2011-1/2015 in an interdisciplinary outpatient rehabilitation program that addresses health literacy, risk factors, physical, psychosocial, cognitive, communicative and vocational issues. Results: Among 96 consecutive patients (69 ischemic, 27 hemorrhages), with admit NIHSS scores 0-16, there were 59 men, 37 women, with an age range of 18-90 years. At baseline(admission to the outpatient program), 36.5% were aphasic(communication impairment), 88% had impairments and needed assistance with activities of daily living (55% and 33% with modified Rankin Scale [mRS] Scores of 3 and 4, respectively), compared with mild impairments (12%mRS 1-2). Of 46 patients working pre-stroke, 48% had returned to work and an additional 13% were work capable at discharge. Of 86 patients driving pre-stroke, 38% returned to driving at completion of the program and 27% began using public transportation. Stroke Impact Scale (SIS) stroke recovery Domain scores increased an average of 38%, SIS ADL scores 33%, SIS mood scores 17%. Cardiovascular and medication education sessions with the Nurse Practitioner(NP) were based on AHA guidelines that included Life’s Simple 7’s curriculum. Stroke Knowledge scores improved an average of 14% and stroke risk factor knowledge improved an average of 19% across program participants. Program treatment also emphasized blood pressure control and exercise, with all but 1 patient receiving an average of 23 physical therapy visits over the duration of program involvement. Compared with baseline, 6 minute walk and Berg Balance scores improved an average of 79% and 33%, respectively. Blood pressures(BPs) measured during the 1st 75% of PT visits were compared to BPs during the last 25%. 56% of patients had fewer moderate(140-159/91-99) to severe(>160/100) BPs and more normal(<120/80) to mild (121-139/81-90) range BPs. 15% had no change in mild-normal range and 29% had some worsening of BPs over the course of PT treatment. Conclusions: Participants in our interdisciplinary community-based rehabilitation program demonstrated improvements in stroke knowledge, physical function, blood pressure control, and mood, while also returning to work, driving, and participation in the community. Comparative research and multi-site studies are needed.