Activity limitations experienced by people with stroke who receive inpatient rehabilitation: differences between 2001, 2005, and 2011.

OBJECTIVE: To determine whether there were differences in characteristics and activity limitations relevant to physiotherapists among people receiving inpatient rehabilitation after stroke in 2001, 2005, and 2011. DESIGN: A multicenter observational study of 3 periods. SETTING: Inpatient rehabilitation units (N=15). PARTICIPANTS: Adult stroke survivors (N=738) admitted over 3 periods (2001, 2005, 2011). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Characteristics, hospital metrics, and Motor Assessment Scale (MAS) scores were recorded on admission and discharge. RESULTS: All 3 cohorts were similar in terms of sex, side affected by stroke, and length of time from stroke onset to rehabilitation admission. Stroke participants in the 2005 cohort were older than those in the 2011 and 2001 cohorts. Participants in the 2011 cohort had a longer inpatient rehabilitation length of stay, experienced lower average MAS gains per day (F>3.298, P<.038), and experienced more activity limitations in basic functional tasks involving bed mobility, standing up, and sitting balance on admission and discharge, and in walking and arm function at discharge only compared with earlier cohorts. CONCLUSIONS: In 2011, on average, people admitted for rehabilitation after stroke were approximately the same age as patients in 2005 and 2001 and it took approximately 2 weeks for all of these patients to be admitted to a rehabilitation unit, but patients in 2011 had a longer inpatient rehabilitation length of stay compared with patients in 2005 and 2001. In addition, activity limitations at inpatient rehabilitation admission and discharge appear to be worse, particularly for activities such as rolling, sitting up over the edge of the bed, and balanced sitting.

Measures of activity limitation on admission to rehabilitation after stroke predict walking speed at discharge: an observational study.

QUESTION: Which measures of activity limitation on admission to rehabilitation after stroke best predict walking speed at discharge? DESIGN: Prospective observational study. PARTICIPANTS: 120 people with stroke undergoing inpatient rehabilitation. OUTCOME MEASURES: Predictors were admission walking speed, Timed Up and Go, Motor Assessment Scale, Modified Elderly Mobility Scale, and Functional Independence Measure scores measured on admission to rehabilitation. The outcome of interest was walking speed at discharge from inpatient rehabilitation. RESULTS: Admission walking speed (B 0.47, 95% CI 0.27 to 0.67) and Item 2 of the Motor Assessment Scale, ie, moving from supine lying to sitting over the side of a bed (B 0.05, 95% CI 0.01 to 0.09) predicted walking speed on discharge from rehabilitation. These two predictors explained 36% of the variance in discharge walking speed. CONCLUSION: Walking speed at discharge from inpatient rehabilitation was best predicted by admission walking speed and Motor Assessment Scale Item 2.

Prediction of discharge destination after stroke using the motor assessment scale on admission: a prospective, multisite study.

OBJECTIVE: To determine if admission functional status, measured with the Motor Assessment Scale (MAS), was predictive of discharge destination to home or residential aged care in patients with stroke undergoing rehabilitation. DESIGN: Cohort study. SETTING: Inpatient rehabilitation units. PARTICIPANTS: Adults (N=566) diagnosed with stroke undergoing inpatient physiotherapy at one of 15 units in Australia. INTERVENTION: Multidisciplinary rehabilitation. MAIN OUTCOME MEASURE: Discharge home versus residential aged care. RESULTS: Prestroke residential status, gait ability measured with the MAS (MAS-5), rolling ability (MAS-1), and age were able to correctly predict 99% of patients with stroke discharged home and 33.3% discharged to residential aged care facilities, producing an accuracy of 87.3%. Odds ratios indicate that for every 1-point increase in MAS-5 (gait), subjects were 1.66 times more likely to go home (95% confidence interval [CI], 1.28-2.27; P<.001). Similarly, for every 1-point increase in MAS-1 (rolling), subjects were 1.28 times more likely to go home (95% CI, 1.11-1.49; P<.01). CONCLUSIONS: Two items of the MAS assessed on admission to rehabilitation-gait and rolling-in conjunction with basic demographic information of age and prestroke residential status, were highly predictive of discharge from rehabilitation to home.