Abstract
Objectives
Cognitive impairment is highly prevalent after stroke, with 77% of people having impairment
in at least 2 cognitive domains. The purpose of this study is to describe the association
between therapy minutes per length of stay (LOS) day and cognitive recovery in patients
receiving rehabilitation services in inpatient post-acute care facilities following
a stroke.
Design
Secondary analyses of data collected in inpatient rehabilitation and skilled nursing
facilities from 2005 to 2010 for an observational cohort study.
Setting and Participants
Participants were adults aged ≥65 years with Medicare insurance and primary diagnosis
of stroke (N = 100). Participants who met criteria for dementia (n = 5) were excluded
from analyses. We calculated therapy minutes per LOS day for occupational therapy,
physical therapy, speech-language pathology, and all therapies combined; therapy times
were dichotomized into high or low minutes per LOS day (MLD). We used an ordinary
least squares regression model for cognitive outcome at discharge to control for cognitive
status at admission, therapy intensity by discipline, and LOS.
Results
At baseline, participants were classified as having severe (n = 11), moderate (n = 39),
or mild (n = 45) cognitive impairment. Impairment groups were not significantly different
on any demographic variables. The adjusted regression model showed that high occupational
therapy MLD (>50 minutes per LOS day) (P = .028) was significantly associated with cognitive measure at discharge compared
with low occupational therapy MLD when controlling for cognitive impairment group
at baseline (P < .001). Neither high physical therapy MLD nor speech-language pathology MLD was
significantly associated with cognitive outcome relative to their respective low TMLD
groups.
Conclusions and Implications
Our results show that higher-intensity occupational therapy services were associated
with better cognitive outcome at discharge from inpatient rehabilitation after stroke.
Findings also suggest that volume of therapy alone does not necessarily produce optimal
outcomes. Both amount and type of therapy should be tailored to meet the needs of
individual patients.
Keywords
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Article info
Publication history
Published online: December 09, 2020
Footnotes
The original study that enabled the collection of the data for the submitted work was funded by Department of Education, National Institute on Disability and Rehabilitation Research Rehabilitation Research and Training Center on Measuring Rehabilitation Outcomes and Effectiveness (Award Number: H133B040032) to Allen Heinemann, PhD, at the Rehabilitation Institute of Chicago (now the Shirley Ryan Ability Lab). T.M. was a co-investigator on that original funding. The funder had no role in design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.
A.M.C. was supported by a Polytrauma/TBI Advanced Fellowship funded by Veterans Health Affairs Office of Academic Affiliations at the time this analysis was conducted.
The authors declare no conflicts of interest.
Identification
Copyright
Published by Elsevier Inc. on behalf of AMDA - The Society for Post-Acute and Long-Term Care Medicine.
