The prediction of functional outcome after stroke

Abstract

Early assessment after stroke is clinically important because it provides early identification of deficits and strengths, and can direct appropriate early intervention. Measures that can predict outcome also allow clinicians to focus on specific areas to target for intervention. This study examined the ability of measures of demographic factors, physical functioning; cognitive functioning; and emotional factors to predict post-stroke outcome. The physical measure used was the Functional Independence Measure (FIM). Cognitive assessments included verbal and visual learning tests, measures of auditory and visual attention and information processing. The Beck Depression and Beck Anxiety Inventories were used to screen for emotional functioning. Thirty participants who had had a stroke were assessed across measures at admission to a rehabilitation facility and 3-months post admission. Results of these intake and 3- month assessments were then used to predict outcome at 6-months post-intake. Outcome at six months was measured using a health related quality of life instrument (Short Form-36; SF-36). An age and education matched control group was assessed on one occasion to allow quantification of the impact of stroke on measures of cognition and mood. The main finding of the study was that mood factors (i.e, anxiety and depression) at intake and 3-months assessments were also significantly related to the SF-36 outcome domains. Regression models used to predict outcome showed that anxiety measured at 3 months post intake was related to decreased health related quality of life. Other findings were that stroke participants experienced decreased cognitive abilities as a consequence of stroke and although they improved somewhat in the first 3 months, they did not reach the level of cognitive performance of controls. Results from correlational analysis suggest that increasing age and increased length of inpatient stay was associated with poorer outcome, as was poorer physical functioning and decreased cognitive ability. Currently in New Zealand 81% of inpatients do not have access to psychologists and very few inpatients have a mood assessment (Gommans et al., 2003). Given the extent of cognitive and mood difficulties identified, the results from the current study have implications for the rehabilitation and psychological services offered to inpatients in New Zealand. In addition to physical and occupational rehabilitation, these results point to the need to screen for and target mood disorders.