Pm. Pedersen et al., ORIENTATION IN THE ACUTE AND CHRONIC STROKE PATIENT - IMPACT ON ADL AND SOCIAL ACTIVITIES - THE COPENHAGEN STROKE STUDY, Archives of physical medicine and rehabilitation, 77(4), 1996, pp. 336-339
Objectives: To determine the influence of initially lowered orientatio
n on rehabilitation outcome in stroke patients, and how decreased orie
ntation 6 months after stroke influences ADL and social activities. De
sign: Prospective, consecutive, and community based. Setting: A stroke
unit receiving all acute stroke patients from a well-defined catchmen
t area. All stages of rehabilitation were completed within the unit. P
atients: 524 patients with acute stroke. Main Outcome Measures: Basic
ADL assessed by the Barthel Index (BI) at discharge; discharge placeme
nt; higher level ADL and social functions assessed by the Frenchay Act
ivity Index (FAI) at a B-month follow-up. Results: The independent inf
luence of orientation in acute stroke on rehabilitation outcome was an
alyzed with multiple linear and logistic regression models, using init
ial stroke severity (Scandinavian Neurologic Stroke Scale), initial BI
, age, sex, comorbidity, prior stroke, and marital status as covariate
s. A one-point decrease in orientation decreased BI with 9 points (coe
fficient b = 8.66, SE(b) = 1.02, p < .0001) and reduced the likelihood
(1.49, 95% CI: 1.05 to 2.11) of discharge to independent living (b =
.40, SE(b)= .18, p = .026). Followup examinations 6 month poststroke s
howed that decreased orientation at this point still exerted a marked,
negative influence on ADL and social functions (BI: coefficient b = 1
2.06, SE(b) = 1.95, p < .0001; FAI: coefficient b = 6.28, SE(b) = 1.42
, p < .0001). Conclusion: The level of orientation influences basic AD
L and higher level ADL and social activities in acute as well as chron
ic stroke. This finding suggests that rehabilitation of memory and att
ention might be relevant in stroke patients with impaired orientation.
(C) 1996 by the American Congress of Rehabilitation Medicine and the
American Academy of Physical Medicine and Rehabilitation