A narrative review of the impact of medical comorbidities on stroke rehabilitation outcomes

Tam, Alan; Bayley, Mark

doi:10.1080/09638288.2017.1309465

Cited by 14 publications

(9 citation statements)

References 33 publications

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“…There are other factors that may mediate the relationship between sleep and functionality poststroke rehabilitation. Types of medications, 50 , 51 social support, 52 , 53 severity 54 and type 55 of comorbid conditions, and socioeconomic status 56 have been shown to influence recovery after stroke. However, there were no group difference between the “good sleepers” and “poor sleepers” in number of medications, use of stimulant or sleep aid, number of comorbidities, marital status, and highest degree earned.…”

Section: Discussionmentioning

confidence: 99%

Association Between Sleep Duration and Functional Disability in Inpatient Stroke Rehabilitation: A Pilot Observational Study

Williams-Cooke¹,

Watts²,

Bonnett³

et al. 2021

Archives of Rehabilitation Research and Clinical Translation

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Objective To describe the change in sleep duration during inpatient rehabilitation and to determine if sleep quality and sleep duration is associated with functional disability for individuals after stroke. It was hypothesized that participants who experienced optimal sleep during inpatient rehabilitation would have greater functional ability at discharge. Design Longitudinal observation study. Setting Inpatient rehabilitation unit at a large, urban hospital. Participants Thirty-seven individuals with acute stroke (N=37; mean age, 62.5±11.8y, male=20, female=17) were recruited from September 2018 to September 2019. Participants were invited to participate in the study by clinical personnel associated with their usual care as they were admitted to inpatient rehabilitation. Interventions Not applicable. Main Outcome Measures Participants were asked to wear an actigraph for the duration of their rehabilitation program to assess sleep. The first 3 nights of actigraphy data were averaged to obtain total sleep time (TST) and sleep efficiency (SE) at admission, and the last 3 nights were averaged for TST and SE at discharge. Functional disability (primary outcome was FIM) at admission and discharge was gathered from the participants’ medical records. One-way analysis of variance and chi-square analyses assessed for group differences, and regression modeling was used to determine if sleep was associated with functional ability at discharge. Results Sixteen participants (43%) were categorized as “good sleepers” and 21 (57%) were “poor sleepers” based on their TST at admission. Of the poor sleepers, 14 participants (66%) remained short duration sleepers (<7h at admission and discharge). Sleep outcomes did not significantly predict FIM score at discharge. Conclusions Most participants had less than optimal sleep duration during inpatient rehabilitation. Efforts may be warranted to optimize sleep during inpatient rehabilitation.

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Section: Discussionmentioning

confidence: 99%

Association Between Sleep Duration and Functional Disability in Inpatient Stroke Rehabilitation: A Pilot Observational Study

Williams-Cooke¹,

Watts²,

Bonnett³

et al. 2021

Archives of Rehabilitation Research and Clinical Translation

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show abstract

“…Further work should compare the utility of different measures of multimorbidity in a community setting. Additionally, examination of any associations between multimorbidity and other rehabilitation outcomes, such as functional change, merits examination [26]. Further research is needed to allow: (1) better risk stratification of individuals with multimorbidity with a history of stroke or TIA; and (2) development and testing of complex interventions aimed at improving health-related outcomes for these individuals.…”

Section: Discussionmentioning

confidence: 99%

Risk Factors and Mortality Associated with Multimorbidity in People with Stroke or Transient Ischaemic Attack: A Study of 8,751 UK Biobank Participants

et al. 2018

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BackgroundMultimorbidity is common in stroke, but the risk factors and effects on mortality remain poorly understood.ObjectiveTo examine multimorbidity and its associations with sociodemographic/lifestyle risk factors and all-cause mortality in UK Biobank participants with stroke or transient ischaemic attack (TIA).DesignData were obtained from an anonymized community cohort aged 40–72 years. Overall, 42 comorbidities were self-reported by those with stroke or TIA. Relative risk ratios demonstrated associations between participant characteristics and number of comorbidities. Hazard ratios demonstrated associations between the number and type of comorbidities and all-cause mortality. Results were adjusted for age, sex, socioeconomic status, smoking, and alcohol intake. Data were linked to national mortality data. Median follow-up was 7 years.ResultsOf 8,751 participants (mean age 60.9±6.7 years) with stroke or TIA, the all-cause mortality rate over 7 years was 8.4%. Over 85% reported ≥1 comorbidities. Age, socioeconomic deprivation, smoking and less frequent alcohol intake were associated with higher levels of multimorbidity. Increasing multimorbidity was associated with higher all-cause mortality. Mortality risk was double for those with ≥5 comorbidities compared to those with none. Having cancer, coronary heart disease, diabetes, or chronic obstructive pulmonary disease significantly increased mortality risk. Presence of any cardiometabolic comorbidity significantly increased mortality risk, as did any non-cardiometabolic comorbidity.ConclusionsIn stroke survivors, the number of comorbidities may be a more helpful predictor of mortality than type of condition. Stroke guidelines should take greater account of comorbidities, and interventions are needed that improve outcomes for people with multimorbidity and stroke.

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“…There is no universal guideline regarding which medical comorbidities should be accounted for in rehabilitation research. Nonetheless, a variety of medical comorbidities are known to influence the rehabilitation length of stay as well as impairment and disability outcomes in patients with strokes and TBIs 5‐9 …”

Section: Introductionmentioning

confidence: 99%

Capture rates of comorbidity measures at inpatient rehabilitation facilities after a stroke or brain injury

Robbins

Goldstein

Siddiqui

et al. 2021

PM&R

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Background Comorbidity indices have been used to represent the overall medical complexity of patient populations in clinical research; however, it is not known how well they capture the comorbidities of patients with a stroke or brain injury admitted to inpatient rehabilitation facilities (IRFs). Objective To determine how well commonly used comorbidity indices capture the comorbidities of patients admitted to IRFs after a stroke or brain injury. Design Cross‐sectional, retrospective study. Setting IRFs nationwide. Participants Adults from four impairment groups: (1) hemorrhagic stroke, (2) ischemic stroke, (3) nontraumatic brain injury (NTBI), and (4) traumatic brain injury (TBI). Main Outcome Measures International Classification of Diseases, Tenth Revision, Clinical Modification (ICD‐10‐CM) codes were extracted from the Uniform Data System for Medical Rehabilitation (UDSMR) for IRF discharges from October 1, 2015 to December 31, 2017. The percentage of discharges captured by Deyo‐Charlson, Elixhauser, and Centers for Medicare and Medicaid Services (CMS) tiers was determined, as was the percentage of comorbidities captured. These measures were also compared with respect to their ability to capture chronic medical complexity by examining the percentage of codes captured after removal of codes deemed to represent hospital complications or sequela of the admission diagnosis. Results The percentage of discharges without at least one ICD‐10‐CM code captured by any index ranged from 0.3%‐3.8%. The percentage of comorbidities with a prevalence exceeding 1% captured by at least one index ranged from 37.1%‐43.6%. Chronic comorbidities were most likely to be captured by Elixhauser (40.7%‐44.4%), followed by Deyo‐Charlson (7.8%‐9.6%), then CMS tiers (4.5%‐6.9%). Existing comorbidity measures capture most IRF discharges related to a brain injury or stroke, whereas most medical comorbidities escape representation. Several common, functionally relevant diagnoses were not captured. Conclusion The use of comorbidity indices in the IRF neurologic injury population should account for the fact that these measures miss several common, important comorbidities.

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A narrative review of the impact of medical comorbidities on stroke rehabilitation outcomes

Cited by 14 publications

References 33 publications

Association Between Sleep Duration and Functional Disability in Inpatient Stroke Rehabilitation: A Pilot Observational Study

Association Between Sleep Duration and Functional Disability in Inpatient Stroke Rehabilitation: A Pilot Observational Study

Risk Factors and Mortality Associated with Multimorbidity in People with Stroke or Transient Ischaemic Attack: A Study of 8,751 UK Biobank Participants

Capture rates of comorbidity measures at inpatient rehabilitation facilities after a stroke or brain injury

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