Dependency in Activities of Daily Living During the First Year After Stroke

Abstract

Background: Dependency in personal activities of daily living (ADL) is a common short-term and long-term consequence of stroke and requires targeted rehabilitation. As the duration of hospital stay has become shorter in recent decades, early identification of patients who require rehabilitation has become vital. To our knowledge, no study has investigated whether ADL dependency in the very early stages after admission to the stroke unit can explain ADL dependency 3 and 12 months later. This knowledge would facilitate planning for very early discharge and patient-centered rehabilitation. Objective: This study evaluated whether ADL dependency within 2 days after stroke could explain ADL dependency at 3 and 12 months after stroke. Methods: This longitudinal cohort study included patients with stroke who were treated at a stroke unit in the Sahlgrenska University Hospital (Gothenburg, Sweden) between May 2011 and March 2016. The primary independent variable was ADL dependency at 36-48 h after admission to the stroke unit, which was assessed using a Barthel Index (BI) score of ≤90. The dependent variables were self-reported personal ADL dependency at 3 and 12 months after stroke. Binary logistic regression analyses were performed. Results: Of 366 eligible patients (58% male; median age 71 years), a majority (76%) had mild stroke and 60% were ADL dependent 36-48 h after stroke. Univariable and multivariable logistic regression analyses showed that patients who were dependent within the first 2 days after stroke had higher odds for being dependent 3 months as well as 12 months after stroke. Conclusion: The results indicated that dependency in personal ADL during the first 2 days can explain dependency at 3- and 12-month post-stroke. Therefore, early ADL assessments post-stroke can be used for understanding rehabilitation needs after stroke.

Keywords: activities of daily living; cross validation (CV); logistic regression; longitudinal studies; outcome assessment; p-ADL; prognosis; stroke rehabilitation adherence.

Figure 1

Directed acyclic graph showing factors that might confound the relationship between early and later ADL outcomes. Age, stroke severity, and cognitive impairment were identified as the minimal sufficient adjustment set. ADL, activities of daily living; BI, Barthel Index.

Figure 2

Study flowchart.

Figure 3

Activities of daily living performance at four different time points. Statistics, McNemar's test, P-values indicate statistical difference between following time points, ADL dependency before the stroke and 36–48 h after stroke, 36–48 h and 3 months after stroke, 3 and 12 months after the stroke.