Abstract
Objectives
This study explored the association between cognitive impairment at admission with
self-care and mobility gain rate (amount of change per week) during a post-acute care
stay (admission to discharge) for older adults with stroke.
Design
Retrospective cohort study.
Setting and Participants
Four inpatient rehabilitation and 6 skilled nursing facilities. A total of 100 adults
with primary diagnosis of stroke; mean age 79 years (SD 7.7); 67% women.
Methods
Retrospective cohort study. We evaluated the extent to which cognitive impairment
at admission explained variation in weekly gain rate separately for self-care and
mobility. Additional covariates were occupational and physical therapy minutes per
day, self-care and mobility function at admission, age, and number of comorbidities.
Results
Participants were classified as having severe (n = 16), moderate (n = 39), or mild
(n = 45) cognitive impairment at admission. Occupational therapy minutes per day (β =
0.04; P < .01) and Functional Independence Measure (FIM) self-care function at admission
(β = 0.48; P < .01) were both significantly associated with self-care gain rate (Adjusted R2 = 0.18); cognitive impairment group, age, and number of comorbidities were not significant.
Only FIM mobility function at admission (β = 0.29; P < .001) was significantly associated with mobility gain rate (Adjusted R2 = 0.18); cognitive impairment group, physical therapy minutes, age, and number of
comorbidities were not significant.
Conclusions and Implications
These results provide preliminary evidence that patients with stroke who have severe
cognitive impairment may benefit from intensive therapy services as well as less severely
impaired patients, particularly occupational therapy for improvement in self-care
function.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Journal of the American Medical Directors AssociationAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Hospital-based stroke rehabilitation in the United States.Top Stroke Rehabil. 2009; 16: 34-43
- Medicare Payment Policy: Report to Congress.(Washington, DC: Medicare Payment Advisory Commission)http://www.medpac.gov/docs/default-source/reports/mar18medpac_entirereport_sec.pdfDate: 2018Date accessed: December 15, 2020
- Cognitive-motor interference during functional mobility after stroke: state of the science and implications for future research.Arch Phys Med Rehabil. 2013; 94: 2565-2574.e6
- Gait and balance one year after stroke; relationships with lesion side, subtypes of cognitive impairment and neuroimaging findings-a longitudinal, cohort study.Physiotherapy. 2019; 105: 254-261
- The Mini-Mental State Examination and Montreal Cognitive Assessment in persons with mild subacute stroke: relationship to functional outcome.Arch Phys Med Rehabil. 2011; 92: 792-798
- Association between mild vascular cognitive impairment and impaired activities of daily living in older stroke survivors without dementia.J Am Geriatr Soc. 2005; 53: 103-107
- Prediction of post-stroke functional mobility from the initial assessment of cognitive function.NeuroRehabilitation. 2017; 41: 169-177
- A comparison of discharge functional status after rehabilitation in skilled nursing, home health, and medical rehabilitation settings for patients after lower-extremity joint replacement surgery.Arch Phys Med Rehabil. 2011; 92: 712-720
- A comparison of discharge functional status after rehabilitation in skilled nursing, home health, and medical rehabilitation settings for patients after lower-extremity joint replacement surgery.Arch Phys Med Rehabil. 2011; 92: 712-720
- Comparison of discharge functional status after rehabilitation in skilled nursing, home health, and medical rehabilitation settings for patients after hip fracture repair.Arch Phys Med Rehabil. 2014; 95: 209-217
- The Functional Independence Measure: tests of scaling assumptions, structure, and reliability across 20 diverse impairment categories.Arch Phys Med Rehabil. 1996; 77: 1101-1108
- Measuring disability in Medicare home care patients: application of Rasch modeling to the outcome and assessment information set.Med Care. 2003; 41: 601-615
- Reliability estimates for the Minimum Data Set for nursing home resident assessment and care screening (MDS).Gerontologist. 1995; 35: 172-178
- Combining items from 3 federally mandated assessments using Rasch measurement to reliably measure cognition across postacute care settings.Arch Phys Med Rehabil. 2021; 102: 106-114
- Defining severe dementia with the Minimum Data Set.Int J Geriatr Psychiatry. 2006; 21: 1099-1106
- Discharge to community-post acute care (PAC) skilled nursing facility quality reporting program (Required under the IMPACT Act) (CMS Measures Inventory Tool).https://cmit.cms.gov/CMIT_public/ReportMeasure?measureRevisionId=18214Date: 2020Date accessed: January 15, 2021
- Input on Standardized Patient Assessment Data Elements (SPADEs) Received after November 27, 2018 Stakeholder Meeting.https://www.hhs.gov/guidance/document/spades-received-after-november-272018-stakeholder-meetingDate: 2019Date accessed: January 15, 2021
- National Field Test Assessment Protocol: Non-communicative.https://www.hhs.gov/guidance/document/national-field-test-assessment-protocolDate: 2017Date accessed: January 15, 2021
Article info
Publication history
Published online: September 01, 2022
Footnotes
The original study that enabled the collection of the data for the submitted work was funded by the 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. 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 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.
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.
