Changes in the Activity Measure for Post-Acute Care Domains in Persons With Stroke During the First Year After Discharge From Inpatient Rehabilitation
| Autor: | Michael W. O'Dell, Erica Kwong, Megan Frantz, Michael Taub, Ruchi Patel, Karen Wen, Marc Campo, Abhishek Jaywant, Joan Toglia |
|---|---|
| Rok vydání: | 2020 |
| Předmět: |
Male
030506 rehabilitation medicine.medical_specialty Wilcoxon signed-rank test medicine.medical_treatment Physical Therapy Sports Therapy and Rehabilitation Cohort Studies 03 medical and health sciences 0302 clinical medicine Activities of Daily Living Outcome Assessment Health Care Medicine Humans Longitudinal Studies Stroke Aged Retrospective Studies Aged 80 and over Academic Medical Centers Inpatients Rehabilitation business.industry Minimal clinically important difference Stroke Rehabilitation Montreal Cognitive Assessment Recovery of Function After discharge Middle Aged medicine.disease Patient Discharge Physical therapy Ceiling effect Female 0305 other medical science business 030217 neurology & neurosurgery Inpatient rehabilitation |
| Zdroj: | Archives of physical medicine and rehabilitation. 102(4) |
| ISSN: | 1532-821X |
| Popis: | Objective To describe functional changes after inpatient stroke rehabilitation using the Activity Measure for Post-Acute Care (AM-PAC), an assessment measure sensitive to change and with a low risk of ceiling effect. Design Retrospective, longitudinal cohort study. Setting Inpatient rehabilitation unit of an urban academic medical center. Participants Among 433 patients with stroke admitted from 2012-2016, a total of 269 (62%) were included in our database and 89 of 269 patients (33.1%) discharged from inpatient stroke rehabilitation had complete data. Patients with and without complete data were very similar. The group had a mean age of 68.0±14.2 years, National Institutes of Health Stroke Score of 8.0±8.0, and rehabilitation length of stay of 14.7±7.4 days, with 84% having an ischemic stroke and 22.5% having a recurrent stroke. Intervention None. Main Outcome Measures Changes in function across the first year after discharge (DC) were measured in a variety of ways. Continuous mean scores for the basic mobility (BM), daily activity (DA), and applied cognitive domains of the AM-PAC were calculated at and compared between inpatient DC and 6 (6M) and 12 months (12M) post DC. Categorical changes among individuals were classified as “improved,” “unchanged,” or “declined” between the 3 time points based on the minimal detectable change, (estimated) minimal clinically important difference, and a change ≥1 A M -PAC functional stage (FS). Results For the continuous analyses, the Friedman test was significant for all domains (P≤.002), with Wilcoxon signed-rank test significant for all domains from DC to 6M (all P .60) and a decline in applied cognition (P=.002). Despite group improvements from DC to 6M, for categorical changes at an individual level 10%-20% declined and 50%-70% were unchanged. Despite insignificant group differences from 6M-12M, 15%-25% improved and 20%-30% declined in the BM and DA domains. Conclusions Despite group gains from DC to 6M and an apparent “plateau” after 6M post stroke, there was substantial heterogeneity at an individual level. Our results underscore the need to consider individual-level outcomes when evaluating progress or outcomes in stroke rehabilitation. |
| Databáze: | OpenAIRE |
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