Abstract T P118: Participation in Extended Activities of Daily Living is an Important Determinant of Long-Term Quality of Life in Stroke Patients after an Early Supported Discharge Program

Abstract

Objective: We previously found stroke patients who underwent home therapy in our Early Supported Discharge (ESD) program had excellent improvement in basic activities of daily living (ADL). Their extended ADL remained impaired after ESD but showed significant improvement after 1 year. We hypothesize that improvement in extended ADL is an important determinant of long-term quality of life (QOL) in this group of stroke patients. Methods: Consecutive stroke patients enrolled in an ESD program in a tertiary hospital in Singapore from August 2007 to July 2012 were recruited. Basic and extended ADL functions were assessed using the Functional Independence Measure (FIM) and Frenchay Activities Index (FAI) respectively, pre- and post-ESD. FAI and SF-36 were administered via telephone interview 1 year after stroke onset. Multiple linear regression analyses with the 8 scales of SF-36 were carried out to determine their associations with variables including age, sex, FIM pre-ESD, FIM change (pre- to post-ESD), premorbid FAI, FAI post-ESD and FAI change (post-ESD to 1 year follow-up). Results: Data from 243 patients (60.9% male, mean age 64.7, SD11.8 years) were available for analysis. They received an average of 7.5 home therapy sessions. FIM improved from 100(17) pre-ESD to 115(15) post-ESD. FAI was 21.7(9.4) premorbid, 11.1(7.6) post-ESD and 17.9(10.3) at 1 year. Multiple regression analyses revealed 8 models which were statistically significant and explained 10-50% of the variance in SF-36 scales. In particular, 50% of the variance in Physical Functioning can be explained by the following factors: female gender (β=-.20, p<.001), FIM pre-ESD (β=.28, p<.001), FIM change (β=.15, p<.01), FAI post-ESD (β=.28, p<.001) and FAI change (β=.40, p<.001). Improvement in FAI scores from post-ESD to 1 year follow-up was positively associated with all 8 scales of SF-36 at 1 year. Conclusion: Compared to improvement in basic ADL after ESD, continued improvement in extended ADL including leisure, work and outdoor activities is a more important determinant of long-term QOL after stroke. Facilitating stroke patients in extended ADL participation and community reintegration after ESD is therefore a potentially important but currently neglected aspect in ESD for stroke patients.