Abstract
ObjectiveTo investigate whether cognition and physical performance, both separately and combined, 3 months post stroke predict change in instrumental activities of daily living (IADL) up to 18 months and whether different paths of IADL could be identified by different scenarios, defined by combinations of high and low scores on physical performance and cognition. DesignThe study is part of the Norwegian Cognitive Impairment After Stroke study, a prospective multicenter cohort study including patients with acute stroke. SettingStroke outpatient clinics at 3 university hospitals and 2 local hospitals. ParticipantsAdult survivors of stroke (N=544) were followed up at 3 and 18 months after stroke. Participants’ mean ± SD age was 72.6±11.8 years, and 235 (43.2 %) were female. InterventionsNot applicable. Main Outcome MeasuresThe primary outcome was IADL as measured by Nottingham Extended Activities of Daily Living. At 3 months, Short Physical Performance Battery (SPPB) and Montreal Cognitive Assessment (MoCA) were used to assess physical performance and cognition, respectively. ResultsMixed-effects linear regression analyses showed that the regression coefficient (95% CI) for the interaction with time was significant for MoCA, 0.238 (CI, 0.030-0.445; P=.025) but not for SPPB. The model combining SPPB and MoCA was significantly better than separate models (likelihood ratio P<.001). Overall, there was no improvement in IADL over time. A combination of SPPB and MoCA score in the upper quartile at 3 months was associated with improved IADL of 1.396 (CI, 0.252-2.540; P=.017) over time. ConclusionsCombining measures of cognition and physical performance gave the best prediction of change in IADL. Function at 3 months seems to be predictive for long-term IADL status, which highlights the importance of targeted rehabilitation in the early and subacute phases after stroke.
Highlights
Because of missing data on Montreal Cognitive Assessment (MoCA), Short Physical Performance Battery (SPPB), National Institutes of Health Stroke Scale (NIHSS), and Nottingham Extended Activities of Daily Living (NEADL), 544 participants were included in the present study
The results indicate that physical performance and cognitive status at 3 months post stroke is predictive of instrumental activities of daily living (IADL) function in the chronic phase after stroke
Being able to predict change in IADL function after stroke is of great value to patients and health care providers
Summary
The present study is part of Nor-COAST, a large multicenter prospective cohort study including participants from 5 different hospitals in Norway between May 2015 and March 2017.23 Patients were screened for inclusion during the index stay, with follow-up assessments at 3, 18, and 36 months. Inclusion criteria were diagnosed with stroke according to the World Health Organization criteria[24] or with findings on magnetic resonance imaging compatible with intracerebral hemorrhage or infarction, symptom onset within 1 week before admission, being older than 18 years, fluency in a Scandinavian language, and living in the catchment area of the participating hospitals. Patients with less than 3 months expected survival were excluded from the study. As indicated by the objective, the present study included data from the 3- and 18-month follow-up only. Participants who completed Nottingham Extended Activities of Daily Living (NEADL), SPPB, and MoCA at 3-month follow-up were included (fig 1)
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