Prognostic factors of functional outcome in post-acute stroke in the rehabilitation unit

Abstract

This retrospective study aimed to determine which factors, such as cognition, motor recovery, swallowing function, and bladder and bowel functions, significantly predicted independence in the activities of daily living (ADL) at hospital discharge in a domestic population of patients experiencing post-acute stroke who received in-hospital rehabilitation. We reviewed medical records that were retrieved from the Integrated Medical Database, National Taiwan University Hospital (NTUH-iMD) of 3000 patients who suffered from stroke and were admitted to NTUH from 2014 to 2017. The main outcome measure was independence in the basic ADL (modified Barthel index [mBI]) at discharge. Regression analyses were used to identify prognostic factors for the basic ADL (mBI). The total mBI improved from 40.7±33.0 to 63.1±34.1 in eligible 2538 patients during their hospital stay. The baseline daily activity function (R2 change=0.042) was the most important prognostic factor associated with independence at discharge, followed by dependence in sitting up (R2 change=0.014), impaired sitting balance (R2 change=0.010), the Brunnstrom stage of hemiplegic lower limb (R2 change=0.006), and the presence of bladder incontinence (R2 change=0.006) assessed by physician upon rehabilitation admission (R2=0.53, p<0.05). Dependency in sitting up, impaired sitting balance, and the presence of urinary incontinence were negative prognostic factors of ADL independence at discharge (p<0.05). By contrast, the Brunnstrom stage of hemiplegic lower limb and baseline mBI scores at rehabilitation admission were positive prognostic factors of ADL independence at discharge (p<0.05). Baseline ADL function was the most important prognostic factor of functional independence in post-acute stroke. Moreover, the activity limitation of dependency on sitting up and motor function impairment of hemiplegic lower limb prognosticated functional independence.