Functional outcomes by age after inpatient stroke rehabilitation in Saudi Arabia

Abstract

BackgroundAmong various risk factors, age has been identified as a nonmodifiable risk factor for stroke that influences functional outcomes after inpatient stroke rehabilitation in the developed world as well as in Saudi Arabia (SA). The demand for inpatient stroke rehabilitation services increases with population aging and stroke incidence; however, these services are limited in SA.ObjectiveTo examine functional outcomes by age after inpatient stroke rehabilitation in SA.Patients and methodsData from 418 patients with stroke who underwent inpatient stroke rehabilitation at the King Fahad Medical City-Rehabilitation Hospital, Riyadh, SA, between November 2008 and December 2014 were collected from electronic medical records. According to the patients’ age, we classified participants into two groups: adults, aged <65 years (n=255), and older adults, aged ≥65 years (n=163). All patients’ functional statuses at admission and discharge from inpatient stroke rehabilitation were assessed using the functional independence measure (FIM) scale.ResultsThe mean age was 59.9 years (SD =9.4). Older adults had significantly smaller changes in functional outcome from admission to discharge on both the total FIM (23 [SD =15.9]) and the motor FIM (21 [SD =15.4]), and they were significantly less independent (36%) compared to adults. In the adjusted models, older adults had significantly lower scores than adults, by 11 points (p<0.0001) for the total FIM score and by 10 points (p<0.0001) for the motor FIM subscale score. There was no significant change with age in the cognitive FIM subscale score.ConclusionAfter inpatient stroke rehabilitation, older adults had limited functional outcomes or were less independent than adults. However, the clinical relevance of this finding is questionable, so there is currently no justification to deny patients access to intensive stroke rehabilitation solely because of advanced age. Future large-scale research is needed to confirm rehabilitation outcomes by including confounders such as social support, socioeconomics, comorbidities, and the patient’s opinion after rehabilitation.

Discharge Destination from a Rehabilitation Unit After Acute Ischemic Stroke

“…Our study was more inclusive of more independent variables than many earlier studies with respect to discharge destination from rehabilitation after acute ischemic stroke. We found discharge destination to be associated with numerous variables at the univariable level: Berg balance score, indicating risk of falling (recently shown by Louie and Eng 21 as a strong predictor of regaining unassisted ambulation), age (as shown previously by Scrutinio et al, Glader et al, and Bindawas et al), 3,18,22 FIM score and improvement in FIM score during the stay on rehabilitation (as shown by Scrutinio et al and Thorpe et al), 3,23 bladder and bowel incontinence (bladder incontinence was also shown to be related to LTC discharge by John et al), 15 ability to transfer (not previously explored), and MoCA score (as shown by Chan et al). 24 The self-perceived functional improvement, dependency for indoor functioning and social relations with family members/caregivers are also determinants in participation and eventual autonomy, 25 but this was not examined in our study.…”

The Influence of Neurological Rehabilitation on Patients’ Quality of Life After Ischemic Stroke: A Prospective Study in Romania

“…Of all the parameters evaluated after the 12-month rehabilitation treatment, perhaps the most significant aspect for the patient is the improvement of the QOL. An increased index of patient's QOL means better social and work reintegration, a lower requirement for medical care, greater autonomy and lower costs for the insurance system and for the family [30].…”

Effectiveness of Early Rehabilitation in Patients With Acute Ischemic Stroke in Neurology Unit

“…Brain stroke usually leaves behind a specific neurological deficit. At this particular time, the question of correct, or rather, effective, organization of rehabilitation activities arises before the neurologists [1,2,5,6]. We were confronted with a question to study and analyze the degree of functional failure after stroke, to evaluate the current system of rehabilitation methods that are currently available in the inpatient unit, to determine ways to improve this area of medical care.…”