Outcomes with stroke and lateropulsion: a case-matched controlled study

Abstract

Background and objective: Lateropulsion after stroke has not been tracked using a case-matched controlled study and a standardized lateropulsion scale. Matched pairs of patients with stroke, with and without lateropulsion, were compared for functional outcomes and discharge destination following inpatient rehabilitation.

Methods: A retrospective chart review of patients with ischemic stroke at an inpatient rehabilitation hospital matched 36 pairs of patients with versus without lateropulsion. Scores of 2 or greater on the Burke Lateropulsion Scale identified lateropulsion. Matching criteria were side of stroke, sex, age, admission motor Functional Independence Measure (FIM), and interval poststroke. FIM efficiency (change in total FIM/length of stay) and discharge destination were analyzed with Wilcoxon signed-ranks tests.

Results: FIM efficiency and discharge FIM scores were lower in the lateropulsion group. Groups had similar mean lengths of stay. Post-hoc analyses showed that only patients with lateropulsion and right brain damage had significantly different FIM efficiency and discharge FIM scores. Lower extremity weakness was greater in the lateropulsion group at discharge; patients with right brain damage accounted for this difference. Patients with lateropulsion required more dependent living situations at discharge, especially if they had right brain damage.

Conclusions: Patients with lateropulsion following stroke have a lower FIM efficiency and more dependency at discharge when compared with matched controls with equal functional limitations. Secondary analyses show worse outcomes for the subgroup of patients with right hemisphere stroke; lateropulsion and greater leg weakness may account for differences. Patients with lateropulsion may require longer rehabilitation to reach outcome goals.