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Poster 23: Change in Activities of Daily Living After Stroke for Community-Dwelling Persons
E12
CONGRESS ANNUAL CONFERENCE ABSTRACTS
Objective: To test 2 hypotheses: (1) that domains of neurobehavioral (cognitive, motor, affective) impairment interact to influence activities of daily living (ADL) disability after stroke, and (2) that cognitive impairment is the best mediator of the effects of neurobehavioral impairment on ADL disability. Design: Secondary analyses and cohort study. Setting: Community. Participants: Convenience sample of 67 participants 3 months after stroke. Interventions: Not applicable. Main Outcome Measures: Mean scores of selected Stroke Impact Scale items measured neurobehavioral domains. The Performance Assessment of Self-care Skills measured ADL disability. Results: Cognitive and motor impairment were independent predictors of ADL disability (F3,63⫽7.36, R2⫽.026, P⬍.001); cognitive impairment was the stronger predictor (⫽.30, P⫽.03). After controlling for cognitive and motor impairment, affective impairment was not an independent predictor. Cognitive impairment mediated the effects of motor and affective impairments on ADL disability. Motor impairment mediated the effects of cognitive and affective impairments on ADL disability. Affective impairment was not a mediator of cognitive or motor impairment. Conclusions: Preliminary data suggest that associations between domains of neurobehavioral impairment and ADL disability are complex, and that cognitive impairment is an important target for stroke rehabilitation intervention. Additional research, using more precise measures of neurobehavioral domains and controlling for additional predictors of ADL disability, is needed. Key Words: Rehabilitation; Stroke. Poster 22 The Unmet Medical Need of Poststroke Upper Motoneuron Syndrome Spasticity: Prevalence and Burden of Illness. Jaime Natoli (Cerner LifeSciences, United States), Jessica Lam, Ross Miller, Amanda VanDenburgh, Aubrey Manack, Bonnie Dean, Suellen Curkendall, Frederick Beddingfield, Haley Kaplowitz. Disclosure: Amanda VanDenburgh, Aubrey Manack, Bonnie Dean, Suellen Curkendall, Frederick Beddingfield, Haley Kaplowitz are employees of Allergan, United States. Objective: To critically review the medical literature to quantify and describe the prevalence and burden of illness after spasticity resulting from cerebrovascular accident. Design: Systematic evaluation of the medical literature. Setting: This comprehensive review searched PubMed and Cochrane databases. Prevalence results were summarized qualitatively. Interventions: Not applicable. Main Outcome Measures: Key functional and health-related quality of life (HRQOL) outcomes relating to spasticity. Results: Prevalence estimates for poststroke spasticity varied widely (5%⫺56%), primarily due to heterogeneity among studies in terms of time since stroke, joint assessed, and methods or instruments used in assessment. The prevalence of spasticity at least 6 months after stroke was estimated between 20% and 50%. Key functional and QOL outcomes included hand function and hygiene, pain, arm disability, HRQOL global response, direct and indirect costs, and caregiver burden. Baseline values in clinical trials suggested that spasticity was associated with increased pain and caregiver burden. Conclusions: The published data on poststroke spasticity is limited by heterogeneity across studies and the lack of population-based analyses. The prevalence of 6-month poststroke spasticity is estimated at 20% to 50%. In addition, clinical trial data indicate that spasticity is associated with increased pain and caregiver burden. Key Words: Burden of illness; Muscle spasticity; Prevalence; Quality of life; Rehabilitation; Stroke. Poster 23 Change in Activities of Daily Living After Stroke for CommunityDwelling Persons. Jeanne Hoffman (University of Washington, United States), Marcia Ciol, Brian Dudgeon, Kathryn Yorkston, Leighton Chan. Disclosure: None declared. Arch Phys Med Rehabil Vol 88, October 2007
Objective: To examine the change in activities of daily living (ADLs) for Medicare beneficiaries who reside in the community in the year after suffering a stroke. Design: Prospective cohort study. Setting: Medicare Current Beneficiary Survey (MCBS) between 1992 and 2000. Participants: 1062 participants in the MCBS who suffered a stroke between 1992 and 2000. Interventions: Not applicable. Main Outcome Measures: Frequency of self-reported ADL difficulty (in walking, transfers, bathing, toileting, dressing, eating) at 3 time points: prior to diagnosis of stroke, interview following stroke, and next yearly interview. Results: More ADL difficulties were reported over time, with the percentage reporting the highest number of ADL difficulties (5 or 6), increasing from 10.3% prestroke, to 16.4% after onset of stroke, to 18.5% 1 year later. At least 41% of participants had no difficulties at all time points (n⫽330). Reporting more ADL difficulties after onset of stroke was associated with prestroke ADL difficulty and older age (both P⬍.000), but not hospital length of stay or other demographic variables. Conclusions: Frequency of ADL difficulties increased after stroke and over time in this cohort of Medicare beneficiaries living in the community. The increase in ADL difficulties appears to be related to ongoing difficulties and increasing age. Key Words: Activities of daily living; Medicare; Rehabilitation; Stroke. Poster 24 Effect of Time to Rehabilitation Admission on Stroke Rehabilitation Outcomes. Hua Wang (Kaiser Foundation Rehabilitation Center, United States), Michelle Camicia, Mary Elizabeth Sandel. Disclosure: None declared. Objective: To examine the association between stroke onset days and rehabilitation outcomes. Design: Retrospective study. Setting: An inpatient rehabilitation facility (IRF) in northern California. Participants: 2037 stroke patients admitted for initial inpatient rehabilitation between 2002 and 2006. Interventions: Not applicable. Main Outcome Measures: Discharge FIM scores (total, motor, cognition), rehabilitation length of stay (LOS), LOS efficiency measured by total FIM gain divided by LOS, and rehabilitation discharge disposition. Results: After controlling for age at admission, sex, race, relative weight of case-mix group, LOS, as well as corresponding admission FIM scores, earlier IRF admission was significantly and linearly associated with higher discharge FIM scores, greater total FIM gain, and higher LOS efficiency (P⬍.001). Patients admitted to IRF early tended to have a shorter LOS and higher percentage discharge disposition to a community setting. Associations of age at admission, sex, race, and patients’ pre-hospital setting were also observed in relation to rehabilitation outcomes. Conclusions: Early admission to IRF was positively associated with motor and cognitive functional improvement in this stroke population, indicating the importance of availability and prompt access of postacute inpatient rehabilitation services. Key Words: Rehabilitation; Stroke; Treatment outcomes. Poster 25 Occupation Classification (Professional, Skilled, and Manual) and Employment After Spinal Cord Injury. Jerry Wright (Santa Clara Valley Medical Center, United States), Tamara Bushnik. Disclosure: None declared. Objective: To examine the relationship between preinjury work classifications (professional, skilled, manual) and employment at 1 year post spinal cord injury (SCI). Design: Prospective longitudinal database. Setting: 15 National Institute on Disability and Rehabilitation Research Model Spinal Cord Injury Systems. Participants: 1759 persons with SCI, between ages 18 and 62 years. Interventions: Not applicable. Main Outcome Measure: Employment at 1 year post-SCI. Results: People were coded as being in 1 of 4 occupation classifications, depending on
CONGRESS ANNUAL CONFERENCE ABSTRACTS
Objective: To test 2 hypotheses: (1) that domains of neurobehavioral (cognitive, motor, affective) impairment interact to influence activities of daily living (ADL) disability after stroke, and (2) that cognitive impairment is the best mediator of the effects of neurobehavioral impairment on ADL disability. Design: Secondary analyses and cohort study. Setting: Community. Participants: Convenience sample of 67 participants 3 months after stroke. Interventions: Not applicable. Main Outcome Measures: Mean scores of selected Stroke Impact Scale items measured neurobehavioral domains. The Performance Assessment of Self-care Skills measured ADL disability. Results: Cognitive and motor impairment were independent predictors of ADL disability (F3,63⫽7.36, R2⫽.026, P⬍.001); cognitive impairment was the stronger predictor (⫽.30, P⫽.03). After controlling for cognitive and motor impairment, affective impairment was not an independent predictor. Cognitive impairment mediated the effects of motor and affective impairments on ADL disability. Motor impairment mediated the effects of cognitive and affective impairments on ADL disability. Affective impairment was not a mediator of cognitive or motor impairment. Conclusions: Preliminary data suggest that associations between domains of neurobehavioral impairment and ADL disability are complex, and that cognitive impairment is an important target for stroke rehabilitation intervention. Additional research, using more precise measures of neurobehavioral domains and controlling for additional predictors of ADL disability, is needed. Key Words: Rehabilitation; Stroke. Poster 22 The Unmet Medical Need of Poststroke Upper Motoneuron Syndrome Spasticity: Prevalence and Burden of Illness. Jaime Natoli (Cerner LifeSciences, United States), Jessica Lam, Ross Miller, Amanda VanDenburgh, Aubrey Manack, Bonnie Dean, Suellen Curkendall, Frederick Beddingfield, Haley Kaplowitz. Disclosure: Amanda VanDenburgh, Aubrey Manack, Bonnie Dean, Suellen Curkendall, Frederick Beddingfield, Haley Kaplowitz are employees of Allergan, United States. Objective: To critically review the medical literature to quantify and describe the prevalence and burden of illness after spasticity resulting from cerebrovascular accident. Design: Systematic evaluation of the medical literature. Setting: This comprehensive review searched PubMed and Cochrane databases. Prevalence results were summarized qualitatively. Interventions: Not applicable. Main Outcome Measures: Key functional and health-related quality of life (HRQOL) outcomes relating to spasticity. Results: Prevalence estimates for poststroke spasticity varied widely (5%⫺56%), primarily due to heterogeneity among studies in terms of time since stroke, joint assessed, and methods or instruments used in assessment. The prevalence of spasticity at least 6 months after stroke was estimated between 20% and 50%. Key functional and QOL outcomes included hand function and hygiene, pain, arm disability, HRQOL global response, direct and indirect costs, and caregiver burden. Baseline values in clinical trials suggested that spasticity was associated with increased pain and caregiver burden. Conclusions: The published data on poststroke spasticity is limited by heterogeneity across studies and the lack of population-based analyses. The prevalence of 6-month poststroke spasticity is estimated at 20% to 50%. In addition, clinical trial data indicate that spasticity is associated with increased pain and caregiver burden. Key Words: Burden of illness; Muscle spasticity; Prevalence; Quality of life; Rehabilitation; Stroke. Poster 23 Change in Activities of Daily Living After Stroke for CommunityDwelling Persons. Jeanne Hoffman (University of Washington, United States), Marcia Ciol, Brian Dudgeon, Kathryn Yorkston, Leighton Chan. Disclosure: None declared. Arch Phys Med Rehabil Vol 88, October 2007
Objective: To examine the change in activities of daily living (ADLs) for Medicare beneficiaries who reside in the community in the year after suffering a stroke. Design: Prospective cohort study. Setting: Medicare Current Beneficiary Survey (MCBS) between 1992 and 2000. Participants: 1062 participants in the MCBS who suffered a stroke between 1992 and 2000. Interventions: Not applicable. Main Outcome Measures: Frequency of self-reported ADL difficulty (in walking, transfers, bathing, toileting, dressing, eating) at 3 time points: prior to diagnosis of stroke, interview following stroke, and next yearly interview. Results: More ADL difficulties were reported over time, with the percentage reporting the highest number of ADL difficulties (5 or 6), increasing from 10.3% prestroke, to 16.4% after onset of stroke, to 18.5% 1 year later. At least 41% of participants had no difficulties at all time points (n⫽330). Reporting more ADL difficulties after onset of stroke was associated with prestroke ADL difficulty and older age (both P⬍.000), but not hospital length of stay or other demographic variables. Conclusions: Frequency of ADL difficulties increased after stroke and over time in this cohort of Medicare beneficiaries living in the community. The increase in ADL difficulties appears to be related to ongoing difficulties and increasing age. Key Words: Activities of daily living; Medicare; Rehabilitation; Stroke. Poster 24 Effect of Time to Rehabilitation Admission on Stroke Rehabilitation Outcomes. Hua Wang (Kaiser Foundation Rehabilitation Center, United States), Michelle Camicia, Mary Elizabeth Sandel. Disclosure: None declared. Objective: To examine the association between stroke onset days and rehabilitation outcomes. Design: Retrospective study. Setting: An inpatient rehabilitation facility (IRF) in northern California. Participants: 2037 stroke patients admitted for initial inpatient rehabilitation between 2002 and 2006. Interventions: Not applicable. Main Outcome Measures: Discharge FIM scores (total, motor, cognition), rehabilitation length of stay (LOS), LOS efficiency measured by total FIM gain divided by LOS, and rehabilitation discharge disposition. Results: After controlling for age at admission, sex, race, relative weight of case-mix group, LOS, as well as corresponding admission FIM scores, earlier IRF admission was significantly and linearly associated with higher discharge FIM scores, greater total FIM gain, and higher LOS efficiency (P⬍.001). Patients admitted to IRF early tended to have a shorter LOS and higher percentage discharge disposition to a community setting. Associations of age at admission, sex, race, and patients’ pre-hospital setting were also observed in relation to rehabilitation outcomes. Conclusions: Early admission to IRF was positively associated with motor and cognitive functional improvement in this stroke population, indicating the importance of availability and prompt access of postacute inpatient rehabilitation services. Key Words: Rehabilitation; Stroke; Treatment outcomes. Poster 25 Occupation Classification (Professional, Skilled, and Manual) and Employment After Spinal Cord Injury. Jerry Wright (Santa Clara Valley Medical Center, United States), Tamara Bushnik. Disclosure: None declared. Objective: To examine the relationship between preinjury work classifications (professional, skilled, manual) and employment at 1 year post spinal cord injury (SCI). Design: Prospective longitudinal database. Setting: 15 National Institute on Disability and Rehabilitation Research Model Spinal Cord Injury Systems. Participants: 1759 persons with SCI, between ages 18 and 62 years. Interventions: Not applicable. Main Outcome Measure: Employment at 1 year post-SCI. Results: People were coded as being in 1 of 4 occupation classifications, depending on