Solomon T1, Ntsiea V1, Comley-White N1
1University of the Witwatersrand, Physiotherapy, Johannesburg, South Africa
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.
Purpose: The aims of this study were to determine the functional outcome in activities of daily living (ADL)s and mobility of first-time stroke survivors upon discharge from an acute inpatient hospital setting, and to determine the factors that influence ADLs and mobility functional outcome at discharge for this population.
Methods: The study was an observational, descriptive cross-sectional study. Consecutively admitted, medically stable, first-time stroke survivors admitted to a South African 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 (BI) and Modified Rivermead Mobility Index (MRMI). Continuous data were summarised as median, interquartile ranges, 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 had ischaemic strokes [n= 52 (87%)], 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 (on BI) with self-care tasks most affected and 32/40 (on 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 = -0.572 and p = 0.000. The correlation between stroke severity and mobility was moderate, negative and significant with r= -0.528 and p= 0.0004.
Conclusion(s): 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.
Implications: This study has provided further knowledge about the functional outcome of patients with stroke upon discharge from the acute, public setting within South Africa. Factors found to influence functional outcome allow for appropriate and efficient discharge planning and inform the development of appropriate procedures to optimise medical and rehabilitative management of acute stroke in South Africa.
Keywords: Stroke, functional outcome, discharge
Funding acknowledgements: This study was not funded.
Purpose: The aims of this study were to determine the functional outcome in activities of daily living (ADL)s and mobility of first-time stroke survivors upon discharge from an acute inpatient hospital setting, and to determine the factors that influence ADLs and mobility functional outcome at discharge for this population.
Methods: The study was an observational, descriptive cross-sectional study. Consecutively admitted, medically stable, first-time stroke survivors admitted to a South African 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 (BI) and Modified Rivermead Mobility Index (MRMI). Continuous data were summarised as median, interquartile ranges, 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 had ischaemic strokes [n= 52 (87%)], 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 (on BI) with self-care tasks most affected and 32/40 (on 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 = -0.572 and p = 0.000. The correlation between stroke severity and mobility was moderate, negative and significant with r= -0.528 and p= 0.0004.
Conclusion(s): 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.
Implications: This study has provided further knowledge about the functional outcome of patients with stroke upon discharge from the acute, public setting within South Africa. Factors found to influence functional outcome allow for appropriate and efficient discharge planning and inform the development of appropriate procedures to optimise medical and rehabilitative management of acute stroke in South Africa.
Keywords: Stroke, functional outcome, discharge
Funding acknowledgements: This study was not funded.
Topic: Neurology: stroke
Ethics approval required: Yes
Institution: University of the Witwatersrand
Ethics committee: Human Research Ethics Committee (medical)
Ethics number: M160531
All authors, affiliations and abstracts have been published as submitted.
