Medical complications experienced by first-time ischemic stroke patients during inpatient, tertiary level stroke rehabilitation

Abstract

[Purpose] The aim of this study was to assess the medical complications in first-time ischemic stroke patients, to identify the factors related to occurrence of complications. [Subjects and Methods] First-time ischemic stroke patients (n=81) admitted to a tertiary level inpatient rehabilitation center during a 5 year period were included in the study. The attending physiatrist noted the presence of specific medical complications and complications that required transfer to the acute care facility from patient records. The Oxfordshire Community Stroke Project classification was used to define the clinical subtypes of the ischemic stroke patients. The Charlson comorbidity index was used to evaluate co-morbid conditions. Functional disability was assessed using the Functional Independence Measure at admission and discharge. [Results] We found that 88.9% of the patients had at least one complication. The five most common complications were urinary tract infection (48.1%), shoulder pain (37.0%), insomnia (37.0%), depression (32.1%), and musculoskeletal pain other than shoulder pain (32.1%) and 11.1% of patients were transferred to acute care facility during rehabilitation period. Functional Independence Measure scores both at admission and discharge were significantly lower in patients with at least one complication than in patients with no complications. [Conclusion] Medical complications are common among patients undergoing stroke rehabilitation. Close interdisciplinary collaboration between physiatrists and other medical specialities is necessary for optimal management.

Quality of life after stroke: impact of clinical and sociodemographic factors

“…This subtype was also associated with better functionality and QoL. Indeed, post-discharge complications were more frequent in patients with TACS in previous studies 3. Arm and hand function in patients with TACS was significantly more compromised than that in patients with LACS and patients with PACS 32.…”

“…Stroke is the third most common cause of death in developed countries and the main cause of death in Latin America. Brazil stands out as having the highest rate of mortality from stroke in the Americas 3,4. In a recent study, the overall survival rate was 47% 5.…”

Comorbidity and intercurrent diseases in geriatric stroke rehabilitation: a multicentre observational study in skilled nursing facilities

“…To our knowledge, this is the first study to focus on comorbidity and intercurrent diseases during geriatric stroke rehabilitation. The study cohort was characterised by a large drop in functional status after acute stroke, often with multiple comorbidities and a higher age compared to the majority of studies on stroke patients [ 5 – 10 , 12 – 14 , 26 ]. Although this subgroup had been triaged for inpatient geriatric rehabilitation, and selected as a vulnerable subgroup of patients on the base of medical complexity and functional dependency, discriminant factors were still present.…”

“…Studies investigating complications during inpatient stroke rehabilitation found that 30–96% of the patients developed complications; this wide range could be due to different definitions of a complication and the methods of measurement [ 5 – 12 ]. The present study investigates intercurrent diseases, i.e.…”

“…any disease that occurs during the progress of another disease, during rehabilitation. Factors related to intercurrent diseases can include age, gender [ 9 , 13 ], time interval between stroke and rehabilitation [ 7 , 10 , 12 ], severe stroke [ 7 , 11 ] or functional impairment [ 6 , 9 , 12 , 13 ] and comorbidity [ 5 – 7 , 13 , 14 ], although it is unknown which specific comorbidities are related. Particularly, older patients are at risk of functional decline and often have multiple comorbidities.…”