on June 26, 2008
Published online before print June 26, 2008, doi: 10.1161/STROKEAHA.107.506329
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Submitted on October 4, 2007
From the Clinical Epidemiology Research Center (M.I.D.), Physical Medicine and Rehabilitation, VA Connecticut Healthcare System, West Haven, Conn; Department of Physiotherapy (S.R.-A.), Brunel University, Uxbridge, UK; and Physical Therapy Program, NOVA Southeastern University, Ft Lauderdale, Fla; Old Dominion University (J.L.E.), Norfolk, Va; and Physical Therapy Program, NOVA Southeastern University, Ft Lauderdale, Fla; Richard L. Roudebush VA Medical Center (D.M.B.), Center of Excellence on Implementing Evidence-Based Practice, Department of Internal Medicine, Indiana University School of Medicine, Indianapolis, Ind; Clinical Epidemiology Research Center, VA Connecticut Healthcare System, West Haven, and Department of Internal Medicine, Yale School of Medicine, New Haven, Conn. * To whom correspondence should be addressed. E-mail: mary.dallas{at}va.gov.
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.
Revised on January 3, 2008
Accepted on January 17, 2008
Dependence in Prestroke Mobility Predicts Adverse Outcomes Among Patients With Acute Ischemic Stroke
Mary I. Dallas PhD*;
Key words: cerebrovascular accident • walking • elderly • outcome assessment
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