Quantifying change during outpatient stroke rehabilitation: A retrospective regression analysis

Publication date: Available online 22 April 2016
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Keith Lohse, Marghuretta D. Bland, Catherine E. Lang
ObjectiveTo examine change and individual trajectories for balance, upper extremity motor capacity, and mobility in people post-stroke during the time they received outpatient therapies.DesignRetrospective analyses of an observational cohort using hierarchical linear modeling.SettingOutpatient rehabilitationParticipants366 persons post strokeInterventionsUsual outpatient physical and occupational therapyMain OutcomesBerg Balance Scale (BBS), Action Research Arm Test (ARAT), and walking speed were used to assess the 3 domains. Initial scores at the start of outpatient therapy (intercepts), rate of change during outpatient therapy (slopes), and the covariance between slopes and intercepts were modeled as random-effects. Additional variables modeled as fixed effects were: Duration (months of outpatient therapy), Time (days post-stroke), Age (years), and Inpatient status (if the patient went to an inpatient rehabilitation facility (IRF)).ResultsA patient with average Age and Time started at 37 points on the BBS with a change of +1.8 points per month, at 35 points on the ARAT with a change of +2.0 points per month, and with a walking speed of 0.59 m/s with a change of +0.09 m/s per month. When controlling for other variables, patients started with lower scores on the BBS and ARAT or had slower walking speeds at admission if they started outpatient therapy later than average or went to an IRF.ConclusionsPatients generally improved over the course of outpatient therapy, but there was considerable variability in individual trajectories. Average rates of change across all three domains were small.



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