Department of Physical Therapy Faculty Articles
Dependence in Prestroke Mobility Predicts Adverse Outcomes Among Patients With Acute Ischemic Stroke
Publication Title
Stroke
Publisher
Lippincott Williams & Wilkins
ISSN
1524-4628
Publication Date
8-2008
Keywords
Activities of Daily Living, Acute Disease, Brain Ischemia, Dependency (Psychology), Disability Evaluation, Geriatric Assessment, Motor Activity, Physical Therapy Modalities, Risk Factors, Stroke Rehabilitation
Abstract
BACKGROUND AND PURPOSE: Stroke survivors are commonly dependent in activities of daily living; however, the relation between prestroke mobility impairment and poststroke outcomes is poorly understood. The primary objective of this study was to evaluate the association between prestroke mobility impairment and 4 poststroke outcomes. The secondary objective was to evaluate the association between prestroke mobility impairment and a plan for physical therapy.
METHODS: This was a secondary analysis of the National Stroke Project data, a retrospective cohort of Medicare beneficiaries who were hospitalized with an acute ischemic stroke (1998 to 2001). Logistic-regression modeling was used to examine the adjusted association between prestroke mobility impairment with patient outcomes and a plan for physical therapy.
RESULTS: Among the 67,445 patients hospitalized with an ischemic stroke, 6% were dependent in prestroke mobility. Prestroke mobility dependence was independently associated with an increased odds of poststroke mobility impairment (odds ratio [OR]=9.9; 95% CI, 9.0 to 10.8); in-hospital mortality (OR=2.4; 95% CI, 2.2 to 2.7); discharge to a skilled nursing facility (OR=3.5; 95% CI, 3.2 to 3.8); and the combination of in-hospital death or discharge to a skilled nursing facility (OR=3.5; 95% CI, 3.3 to 3.8). Prestroke mobility dependence was independently associated with a decreased odds of having a plan for physical therapy (OR=0.79; 95% CI, 0.73 to 0.85).
CONCLUSIONS: These data, obtained from a large, geographically diverse cohort from the United States, demonstrate a strong association between dependence in prestroke mobility and adverse outcomes among elderly stroke patients. Clinicians should screen patients for prestroke mobility impairment to identify patients at greatest risk for adverse events.
DOI
10.1161/STROKEAHA.107.506329
Volume
39
Issue
8
First Page
2298
Last Page
2303
Disciplines
Medicine and Health Sciences
NSUWorks Citation
Dallas, Mary L.; Rone-Adams, Shari; Echternach, John L.; Brass, Lawrence M.; and Bravata, Dawn M., "Dependence in Prestroke Mobility Predicts Adverse Outcomes Among Patients With Acute Ischemic Stroke" (2008). Department of Physical Therapy Faculty Articles. 65.
https://nsuworks.nova.edu/hpd_pt_facarticles/65