Predictors of Gains During Inpatient Rehabilitation in Patients with Stroke: A Review

Abstract

Stroke remains a major cause of disability. The cost of stroke rehabilitation is substantial. Understanding the factors that predict response to inpatient stroke rehabilitation may be useful, for example, to best individualize the content of therapy, or to maximize the efficiency with which resources are directed. This review reviewed the literature and found that numerous variables were associated with outcome after inpatient stroke rehabilitation. The strongest evidence exists for factors such as age, stroke subtype, nutritional status, psychosocial factors such as living with family prior to stroke or presence of a caregiver. Functional status on admission, urinary incontinence, post-stroke infection, and aphasia each can also impact prognosis. Strengths and weaknesses of cited studies are considered in an attempt to inform design of future studies examining the factors that predict response to inpatient rehabilitation after stroke.

Nutritional intake is associated with activities of daily living and complications in older inpatients with stroke

“…Energy intake during week 1 after admission affected the onset of complications during hospitalization. The most common complications after stroke are pneumonia and urinary tract infection . In previous studies, the pneumonia and urinary tract infection rate after stroke was 10.0% .…”

How Do Recurrent and First-Ever Strokes Differ in Rehabilitation Outcomes?

“…This finding has been reported previously whereby admission motor FIM scores do not predict FIM gain, though it is well established that AdmissionFIM is the best predictor of DischargeFIM. 18,30 It is plausible that other factors apart from initial functional status are operative in determining gains for recurrent stroke including comorbidities and social factors. Older age was also not associated with FIM gain in the recurrent stroke patients as compared to first-ever stroke patients.…”

“…The lack of a caregiver in stroke is strongly associated with poorer adherence to therapy, depression, morbidity, mortality, and discharge destination. 11,18 Many of these factors may be operative in recurrent stroke patients which secondarily impacts on functional improvement.…”

“…A physician-led holistic and interdisciplinary approach was consistently practiced in the stroke program. 5,18 All patients received approximately 2 to 3 hours of physical and occupational therapy per weekday with referral to medical social worker, speech therapist, psychologist, or other medical or surgical departments as necessary.…”

Spontaneous and Therapeutic-Induced Mechanisms of Functional Recovery After Stroke

“…Whereas, recovery of visuospatial neglect and orientation follow 5–6 months after stroke [8–10], and gains in cognition [11], memory [12], and language function [13, 14] may extend over a period of months to years post-stroke. Individual factors such as genetics [15–17], previous medical comorbidities, initial severity of deficits, and age [18], stroke mechanism, neuroanatomical details such as lesion size and location, and areas spared injury [19–22] impact recovery.…”