Community Rehabilitation Outcomes for Different Stroke Diagnoses: An Observational Cohort Study

Abstract

Objective: To determine the differences in functional and cognitive rehabilitation gains made in community-based rehabilitation following a stroke based on stroke diagnosis (left or right hemisphere, hemorrhagic, or ischemic).

Design: A 12-month follow-up observational retrospective cohort study.

Setting: Staged community-based brain injury rehabilitation.

Participants: Clients (N=61) with hemorrhagic left brain stroke (n=10), hemorrhagic right brain stroke (n=8), ischemic left brain stroke (n=27), or ischemic right brain stroke (n=16) participating in rehabilitation for at least 12 months.

Intervention: Not applicable.

Main outcome measures: The Mayo-Portland Adaptability Inventory-4 (MPAI-4) was completed at admission and 12 months post admission to staged community-based brain injury rehabilitation by consensus of a multidisciplinary team.

Results: After 12 months in staged community-based brain injury rehabilitation, the study population made significant gains in Total (P<.001) and across Ability (P<.001) and Participation (P<.001) subscales of the MPAI-4. All diagnostic groups made significant gains in Participation T-scores, and no groups made significant gains in Adjustment. The ischemic left and right hemisphere stroke groups also made significant gains in Ability and Total T-scores from admission to 12 months. Clients with ischemic left hemisphere stroke had more severe limitations in motor speech (P<.05) than clients with right hemisphere stroke at admission and/or review and were also more impaired in verbal communication (P<.01) than the hemorrhagic right hemisphere group at admission.

Conclusions: There are some differences in outcomes on presentation to rehabilitation based on type of stroke; there are also differences in rehabilitation gains. Improvement in physical ability does not always translate to improvement in social participation and independence; those with right brain stroke need further assistance to translate physical gains into participatory outcomes.

Keywords: ABI, acquired brain injury; ANOVA, analysis of variance; Brain injuries; MPAI-4, Mayo-Portland Adaptability Inventory-4 (MPAI-4); Rehabilitation; Stroke.

Fig 1

MPAI-4 radar chart showing median change in 29 items from admission to 12 months post admission for the total cohort (n=61). Items are arranged as spokes in the wheel. MPAI-4 scores are inverted, and levels are arranged from severe problem/limitation at the center (4) to no problem/limitation on the outer perimeter (0). The red line represents scores on admission to staged community-based brain injury rehabilitation, and the blue line represents scores following 12 months of staged community-based brain injury rehabilitation.

Fig 2

MPAI-4 radar charts showing median change in 29 items from admission to 12 months post admission for each type of stroke cohort. These show at a glance rehabilitation outcomes for each cohort across 12 months of staged community-based brain injury rehabilitation.