Functional outcome at discharge from an acute inpatient hospital setting following first-time stroke

Abstract

Background: Stroke is a common cause of prolonged disability and often patients are discharged early from hospital without achieving functional independence. Known factors that influence functional outcome following stroke are, amongst others, stroke severity, age and gender.

Aim: To determine the functional outcome in ADLs and mobility of first-time stroke survivors upon discharge from an acute in-patient hospital setting. The objectives were a) to determine the ADL and mobility functional outcome at discharge of patients from an acute inpatient hospital setting following first-time stroke and b) to determine the factors that influence ADLs and mobility functional outcome at discharge from the acute inpatient hospital setting in patients following first-time stroke.

Method: This study was observational, descriptive and cross-sectional. Consecutively admitted, medically stable, first-time stroke survivors admitted to an acute care hospital and who were referred for rehabilitation during hospital stay were screened for eligibility. Participants underwent two assessments upon discharge: the Barthel Index (ADL) and Modified Rivermead Mobility Index (MRMI). Continuous data were summarised as median, IQR, means and standard deviations, minimum and maximum scores. Relationship tests were performed between outcome scores and independent variables. Univariate linear regression was performed between dependent and independent variables. Those with an independent relationship with outcome scores were placed in a multivariate stepwise regression to determine predictive factors of functional outcome in the setting.

Results: Sixty participants (35 Male and 25 female) were recruited. The mean age was 47.5 ± 12.14 and majority of the participants n= 52 (87%) had ischaemic strokes, moderate stroke severity (8.68 ± 4.48) and 20.6 ± 12.19 days length of hospital stay. Rehabilitation was initiated within one week of stroke (4.6 days ± 3.37) and total rehabilitation per day was 25.65 ± 15.07 minutes. Mean functional scores were 75/100 (BI) with self-care tasks most affected and 32/40 (MRMI) with mobility (walking) and stair-climbing most affected. Stroke severity was the single influencing factor found to influence both ADLs and mobility outcomes in this setting. The correlation between stroke severity and ADLs was moderate, negative and significant with r = -0.57 and p = 0.00. The correlation between stroke severity and mobility was moderate, negative and significant with r= -0.52 and p= 0.00.

Conclusion: Functional independence was achieved in some ADLs and mobility items at discharge. Majority of the sample required additional rehabilitation. Stroke severity was the single factor found to influence functional outcome in both ADLs and mobility at discharge.